Objective To explore the effect of composite electromagnetic stimulation combined with chin tuck against resistance(CTAR)on post-stroke dysphagia.Methods From January,2021 to December,2023,156 post-stroke patients with pharyngeal dysphagia in the First Peo-ple's Hospital of Yibin were randomly divided into CTAR group(n=51),neuromuscular electrical stimulation(NMES)+repetitive transcranial magnetic stimulation(rTMS)group(n=52)and combination group(n=53).On the basis of routine swallowing function training,they received CTAR,NMES+rTMS and NMES+rTMS+CTAR,respectively,for four weeks.They were assessed with Functional Oral Intake Scale(FOIS),Standardized Swal-lowing Assessment(SSA),Swallowing-Quality of Life(SWAL-QOL),Rosenbek Penetration Aspiration Scale(PAS),video fluoroscopic swallowing study(VFSS)(including the score of VFSS,pharyngeal transit time,and upward and forward displacement of hyoid bone),average surface electromyography(AMEG)of submental and hyoid muscles,before and after treatment.Results The inter-group effect,intra-group effect and interaction effect were significant in SSA,SWAL-QOL and AMEG of the two muscles(F>6.611,P<0.001).The inter-group effect and interaction effect were significant in FOIS,VFSS,pharyngeal transit time,upward displacement of hyoid bone and forward displacement of hyoid bone(F>3.451,P<0.05).Pairwise comparison results showed that pharyngeal transit time was shorter in the combination group than in NMES+rTMS group(P=0.048),forward displacement of hyoid bone was more in the combina-tion group than in CTAR group(P=0.002),and AMEG was higher in the combination group than in CTAR group and NMES+rTMS group(P<0.001).There was significant difference in the score of PAS among three groups(Hc=8.282,P=0.016),and it was the best in the combination group.Conclusion The combination of NMES+rTMS and CTAR is superior to single electromagnetic stimulation or CTAR in the treatment of post-stroke sysphagia.

Objective:To investigate the current status of vascular access team building and analysis its related factors in hemodialysis centers in China.Methods:The study was a cross-sectional survey. Using a convenience sampling method, a questionnaire was designed to investigate the clinical practice of vascular access teams in 527 hemodialysis centers in China from March to April 2022. The related factors of the formation of vascular access teams and the setting up of vascular access coordinators (VAC) were analyzed by multivariate logistic regression method.Results:A total of 506 valid questionnaires were recovered, with a recovery rate of 96.02%. There were 247 (48.81%) and 193 (38.14%) hemodialysis centers respectively across China that had built vascular access teams and set up VAC. Hemodialysis centers with more than 10 years of practice had higher rate of implementation than those in hemodialysis centers with practice years less or equal than 10 years in developing standardized procedures for vascular access management ( χ 2=8.288, P=0.004), holding continuous quality improvement meetings on vascular access ( χ 2=8.210, P=0.004), establishing vascular access teams ( χ 2=33.805, P<0.001) and setting up vascular access coordinators ( χ 2=16.038, P<0.001), and the difference was statistically significant. The results of multivariate logistic regression analysis showed that the number of dialysis machines ( OR=2.221, 95% CI 1.118-4.415, P=0.023), the number of patients on dialysis( OR=2.946, 95% CI 1.375-6.310, P=0.005), and the establishment of VAC positions ( OR=9.463, 95% CI 5.307-16.874, P<0.001), and the standardized vascular access management process ( OR=3.383, 95% CI 2.012-5.687, P<0.001) were the related factors of vascular access team building. The related factors of setting up a VAC position in hemodialysis center were opening vascular access clinic ( OR=2.704,95% CI 1.382-5.290, P=0.004), the formation of a vascular access team ( OR=9.464, 95% CI 5.312-16.860, P<0.001), and constructing standardized procedures for vascular access management ( OR=3.663, 95% CI 2.243-5.982, P<0.001). Conclusion:The implementation rates of vascular access team and VAC position in hemodialysis centers were 48.81% and 38.14%, respectively. The number of dialysis machines, the number of patients on dialysis, the standardized procedures for vascular access management, the vascular access clinic, the vascular access team, and the VAC position were the relevant factors of the team building for vascular access.

Objective To explore the optimal warning threshold of motor evoked potentials(MEP)in decompression surgery for ossification of the posterior longitudinal ligament(OPLL)at cervical and thoracic segments,and the predictive role of different MEP parameters on postoperative lower extremity motor function.Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital.There were 131 males and 96 females,with an average age of(60±10)years.All patients underwent continuous neuro-physiological monitoring during the operation,and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation(Dmax)and the ratio of MEP terminal amplitude change to the baseline at the end of the operation(Dend)were recorded.The correlations between these two ratios and the lower extremity motor func-tion immediately after the operation and at 1 year were compared.According to the Medical Research Council muscle strength score(MRC)standard,a postoperative score increase of≥1 point compared to preoperative was defined as postoperative motor dysfunction.Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year.Receiver operating characteristic(ROC)curves were drawn to predict postoperative lower extremity motor dysfunc-tion using Dmax and Dend.Results Among the 227 patients,186 had cervical OPLL and 41 had thoracic OPLL.The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases(3.76%)and 2 cases(1.08%)in the cervical group,and 9 cases(21.95%)and 3 cases(7.32%)in the thoracic group,respectively.The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group(P<0.001).The baseline induction rate of bilateral lower extremity MEPs was 98.92%(368/372)in the cervical group and 96.34%(79/82)in the thoracic group.The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax,and the differences were statistically significant(cervical group:r=0.669,0.517,P=0.001 2;thoracic group:r=0.882,0.727,P=0.003 6),while the differences in the Pearson corre-lation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant(cervical group:r=0.457,0.352,P=0.088;thoracic group:r=0.760,0.625,P=0.098).The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year,and the cut-off values of Dmax were 0.881 and 0.978,respectively.For the thoracic group,the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year,and the cut-off values of Dmax were 0.532 and 0.640,respec-tively.Conclusions In OPLL surgery,the MEP monitoring strategy should be adjusted according to the surgical segment.For the cervical segment,Dmax should be emphasized to balance high sensitivity and specificity,while for the thoracic segment,Dmax or Dend can be flexibly selected.Higher MEP warning thresholds are required for cervical OPLL surgery(Dmax:0.881 immediately after the operation and 0.978 at 1 year;Dend:0.853),while significantly lower thresholds are needed for thoracic OPLL(Dmax/Dend:0.532 immediately after the operation and 0.640 at 1 year).

Objective:To investigate the prevalence and influencing factors of post-traumatic stress disorder (PTSD) in thyroid cancer patients.Methods:This cross-sectional study used convenience sampling to recruit thyroid cancer patients from the Thyroid Surgery Department of Harbin Medical University Cancer Hospital between July and September 2023. Data were collected using a general demographic questionnaire, the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), the Perceived Stress Scale (PSS-10), and the Negative Cognitive Processing Bias Questionnaire (NCPBQ) .Results:A total of 210 questionnaires were distributed, and 204 valid responses were returned, yielding a response rate of 97.14% (204/210). Among the respondents, 44 patients (21.57%) tested positive for PTSD, with a PCL-C score of 23 (19, 32). Factors influencing PTSD included age, education level, marital status, monthly income, lateral neck lymph node metastasis, comorbid chronic diseases, perceived stress, and negative cognitive processing bias ( P<0.05) . Conclusions:PTSD symptoms were present in 21.57% of thyroid cancer patients and were influenced by various factors. Healthcare professionals should develop targeted interventions based on patient characteristics to alleviate PTSD symptoms in thyroid cancer patients.

Objective To explore the effect of composite electromagnetic stimulation combined with chin tuck against resistance(CTAR)on post-stroke dysphagia.Methods From January,2021 to December,2023,156 post-stroke patients with pharyngeal dysphagia in the First Peo-ple's Hospital of Yibin were randomly divided into CTAR group(n=51),neuromuscular electrical stimulation(NMES)+repetitive transcranial magnetic stimulation(rTMS)group(n=52)and combination group(n=53).On the basis of routine swallowing function training,they received CTAR,NMES+rTMS and NMES+rTMS+CTAR,respectively,for four weeks.They were assessed with Functional Oral Intake Scale(FOIS),Standardized Swal-lowing Assessment(SSA),Swallowing-Quality of Life(SWAL-QOL),Rosenbek Penetration Aspiration Scale(PAS),video fluoroscopic swallowing study(VFSS)(including the score of VFSS,pharyngeal transit time,and upward and forward displacement of hyoid bone),average surface electromyography(AMEG)of submental and hyoid muscles,before and after treatment.Results The inter-group effect,intra-group effect and interaction effect were significant in SSA,SWAL-QOL and AMEG of the two muscles(F>6.611,P<0.001).The inter-group effect and interaction effect were significant in FOIS,VFSS,pharyngeal transit time,upward displacement of hyoid bone and forward displacement of hyoid bone(F>3.451,P<0.05).Pairwise comparison results showed that pharyngeal transit time was shorter in the combination group than in NMES+rTMS group(P=0.048),forward displacement of hyoid bone was more in the combina-tion group than in CTAR group(P=0.002),and AMEG was higher in the combination group than in CTAR group and NMES+rTMS group(P<0.001).There was significant difference in the score of PAS among three groups(Hc=8.282,P=0.016),and it was the best in the combination group.Conclusion The combination of NMES+rTMS and CTAR is superior to single electromagnetic stimulation or CTAR in the treatment of post-stroke sysphagia.

Objective To explore the optimal warning threshold of motor evoked potentials(MEP)in decompression surgery for ossification of the posterior longitudinal ligament(OPLL)at cervical and thoracic segments,and the predictive role of different MEP parameters on postoperative lower extremity motor function.Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital.There were 131 males and 96 females,with an average age of(60±10)years.All patients underwent continuous neuro-physiological monitoring during the operation,and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation(Dmax)and the ratio of MEP terminal amplitude change to the baseline at the end of the operation(Dend)were recorded.The correlations between these two ratios and the lower extremity motor func-tion immediately after the operation and at 1 year were compared.According to the Medical Research Council muscle strength score(MRC)standard,a postoperative score increase of≥1 point compared to preoperative was defined as postoperative motor dysfunction.Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year.Receiver operating characteristic(ROC)curves were drawn to predict postoperative lower extremity motor dysfunc-tion using Dmax and Dend.Results Among the 227 patients,186 had cervical OPLL and 41 had thoracic OPLL.The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases(3.76%)and 2 cases(1.08%)in the cervical group,and 9 cases(21.95%)and 3 cases(7.32%)in the thoracic group,respectively.The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group(P<0.001).The baseline induction rate of bilateral lower extremity MEPs was 98.92%(368/372)in the cervical group and 96.34%(79/82)in the thoracic group.The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax,and the differences were statistically significant(cervical group:r=0.669,0.517,P=0.001 2;thoracic group:r=0.882,0.727,P=0.003 6),while the differences in the Pearson corre-lation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant(cervical group:r=0.457,0.352,P=0.088;thoracic group:r=0.760,0.625,P=0.098).The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year,and the cut-off values of Dmax were 0.881 and 0.978,respectively.For the thoracic group,the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year,and the cut-off values of Dmax were 0.532 and 0.640,respec-tively.Conclusions In OPLL surgery,the MEP monitoring strategy should be adjusted according to the surgical segment.For the cervical segment,Dmax should be emphasized to balance high sensitivity and specificity,while for the thoracic segment,Dmax or Dend can be flexibly selected.Higher MEP warning thresholds are required for cervical OPLL surgery(Dmax:0.881 immediately after the operation and 0.978 at 1 year;Dend:0.853),while significantly lower thresholds are needed for thoracic OPLL(Dmax/Dend:0.532 immediately after the operation and 0.640 at 1 year).

Objective:To investigate the prevalence and influencing factors of post-traumatic stress disorder (PTSD) in thyroid cancer patients.Methods:This cross-sectional study used convenience sampling to recruit thyroid cancer patients from the Thyroid Surgery Department of Harbin Medical University Cancer Hospital between July and September 2023. Data were collected using a general demographic questionnaire, the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), the Perceived Stress Scale (PSS-10), and the Negative Cognitive Processing Bias Questionnaire (NCPBQ) .Results:A total of 210 questionnaires were distributed, and 204 valid responses were returned, yielding a response rate of 97.14% (204/210). Among the respondents, 44 patients (21.57%) tested positive for PTSD, with a PCL-C score of 23 (19, 32). Factors influencing PTSD included age, education level, marital status, monthly income, lateral neck lymph node metastasis, comorbid chronic diseases, perceived stress, and negative cognitive processing bias ( P<0.05) . Conclusions:PTSD symptoms were present in 21.57% of thyroid cancer patients and were influenced by various factors. Healthcare professionals should develop targeted interventions based on patient characteristics to alleviate PTSD symptoms in thyroid cancer patients.

Objective:To investigate the current status of vascular access team building and analysis its related factors in hemodialysis centers in China.Methods:The study was a cross-sectional survey. Using a convenience sampling method, a questionnaire was designed to investigate the clinical practice of vascular access teams in 527 hemodialysis centers in China from March to April 2022. The related factors of the formation of vascular access teams and the setting up of vascular access coordinators (VAC) were analyzed by multivariate logistic regression method.Results:A total of 506 valid questionnaires were recovered, with a recovery rate of 96.02%. There were 247 (48.81%) and 193 (38.14%) hemodialysis centers respectively across China that had built vascular access teams and set up VAC. Hemodialysis centers with more than 10 years of practice had higher rate of implementation than those in hemodialysis centers with practice years less or equal than 10 years in developing standardized procedures for vascular access management ( χ 2=8.288, P=0.004), holding continuous quality improvement meetings on vascular access ( χ 2=8.210, P=0.004), establishing vascular access teams ( χ 2=33.805, P<0.001) and setting up vascular access coordinators ( χ 2=16.038, P<0.001), and the difference was statistically significant. The results of multivariate logistic regression analysis showed that the number of dialysis machines ( OR=2.221, 95% CI 1.118-4.415, P=0.023), the number of patients on dialysis( OR=2.946, 95% CI 1.375-6.310, P=0.005), and the establishment of VAC positions ( OR=9.463, 95% CI 5.307-16.874, P<0.001), and the standardized vascular access management process ( OR=3.383, 95% CI 2.012-5.687, P<0.001) were the related factors of vascular access team building. The related factors of setting up a VAC position in hemodialysis center were opening vascular access clinic ( OR=2.704,95% CI 1.382-5.290, P=0.004), the formation of a vascular access team ( OR=9.464, 95% CI 5.312-16.860, P<0.001), and constructing standardized procedures for vascular access management ( OR=3.663, 95% CI 2.243-5.982, P<0.001). Conclusion:The implementation rates of vascular access team and VAC position in hemodialysis centers were 48.81% and 38.14%, respectively. The number of dialysis machines, the number of patients on dialysis, the standardized procedures for vascular access management, the vascular access clinic, the vascular access team, and the VAC position were the relevant factors of the team building for vascular access.

Objective:To explore the correlation between post-traumatic stress disorder(PTSD),resilience and quality of life of front-line medical staff in public health emergencies.Methods:From Nov to Dec 2020,the medical staff of 4 COVID-19 designated hospitals in Wuhan were investigated with the general demographic questionnaire,10-item Connor-Davidson Resilience Scale,PTSD Checklist for DSM-5 and Simplify Qualify of Life Scale.Spearman correlation analysis and hierarchical regression analysis were used to investigate the correlation between PTSD,resilience and quality of life.Results:A total of 545 questionnaires were collected in this survey and the valid effective rate was 97.8% (533/545).The score of psychological resilience,PTSD and quality of life of medical staff were 26(20,30),17(8,25),and 20(18,23),respectively.And 13.1% (70/533)of medical staff had obvious PTSD symptoms.There were significant differences in the score of quality of life among medical staff with different genders,occupations and PTSD levels.Spearman correlation analysis results showed that the score of PTSD was negatively correlated with quality of life and psychological resilience(r=-0.488 and-0.464,P＜0.01).The score of psychological resilience was positively correlated with the score of quality of life(r =0.578,P＜0.01).Psychological resilience and PTSD were important predictors of quality of life,with an explanatory capacity of 37.0% .Conclusions:PTSD is a risk factor for quality of life,and psychological resilience is a protective factor for quality of life.In public health emergencies,improving psychological resilience,preventing and treating PTSD can improve the quality of life of medical staff.