Objectives:To investigate the clinical characteristics and prognosis of patients with pulmonary arterial hypertension(PAH)concomitant with obstructive sleep apnea(OSA).Methods:We analyzed the data of 208 patients diagnosed with PAH in the Pulmonary Vascular Diseases Ward of our hospital from September 2019 to August 2024,who underwent sleep breathing monitoring and echocardiography during hospitalization.Three clusters were identified:Cluster 1(n=121)had no OSA and mildly elevated N-terminal pro-B-type natriuretic peptide(NT-proBNP),Cluster 2(n=71)exhibited mild OSA and mildly elevated NT-proBNP,and Cluster 3(n=16)presented with moderate to severe OSA along with significantly elevated NT-proBNP.Results:The mean age of this patient cohort was(39±12)years,mean body mass index was(21.74±3.67)kg/m2,and 27.9%patients were male.Sixty-five patients(31.3%)had OSA.The echocardiographic indicators reflecting the structural function of the heart chambers and hemodynamic parameters in patients with PAH showed a significant correlation with nocturnal hypoxia.Compared to Cluster 1,patients in Cluster 2 and Cluster 3 had wider pulmonary arteries and inferior vena cava diameters,larger right ventricular diameters,higher pulmonary artery pressure,higher pulmonary vascular resistance,and lower cardiac index(all P<0.05).Cluster 3 patients had a significantly higher risk of death(log-rank P=0.022).Conclusions:Thirty-one percent of PAH patients in this study had concomitant OSA.PAH patients with significantly elevated NT-proBNP and comorbid moderate-to-severe OSA had a significantly higher risk of death compared to those with only mild or without OSA without significantly elevated NT-proBNP.Management strategies that address both PAH and OSA might be effective in improving the outcomes of these patients.

Hospitals presently confront multiple challenges, including rapid technological advancements, escalating healthcare demands, and continuously rising healthcare costs, thereby necessitating the introduction of new quality productive forces to drive high-quality hospital development. Adopting the perspective of new quality productive forces, the authors examined the transformation trend from conventional fragmented medical services towards integrated digital healthcare systems. Through the establishment of digital infrastructure characterized by big data, cloud computing, the Internet of Things, and artificial intelligence, hospitals could realize deep integration between inpatient and outpatient care, as well as seamless online and offline service delivery. Concurrently, oriented by the healthcare needs of residents, a precise and efficient " prevention-diagnosis-treatment-rehabilitation" service mode was proposed. This mode could facilitate the extension of innovation and industrial chains originating from healthcare services, expedite the translation of research outcomes into practice, and promote scientifically meticulous hospital management. Collectively, these measures could enable hospitals to develop patient-centered, comprehensive life-cycle healthcare service systems, thereby promoting the high-quality development of hospitals.

Objectives:To investigate the clinical characteristics and prognosis of patients with pulmonary arterial hypertension(PAH)concomitant with obstructive sleep apnea(OSA).Methods:We analyzed the data of 208 patients diagnosed with PAH in the Pulmonary Vascular Diseases Ward of our hospital from September 2019 to August 2024,who underwent sleep breathing monitoring and echocardiography during hospitalization.Three clusters were identified:Cluster 1(n=121)had no OSA and mildly elevated N-terminal pro-B-type natriuretic peptide(NT-proBNP),Cluster 2(n=71)exhibited mild OSA and mildly elevated NT-proBNP,and Cluster 3(n=16)presented with moderate to severe OSA along with significantly elevated NT-proBNP.Results:The mean age of this patient cohort was(39±12)years,mean body mass index was(21.74±3.67)kg/m2,and 27.9%patients were male.Sixty-five patients(31.3%)had OSA.The echocardiographic indicators reflecting the structural function of the heart chambers and hemodynamic parameters in patients with PAH showed a significant correlation with nocturnal hypoxia.Compared to Cluster 1,patients in Cluster 2 and Cluster 3 had wider pulmonary arteries and inferior vena cava diameters,larger right ventricular diameters,higher pulmonary artery pressure,higher pulmonary vascular resistance,and lower cardiac index(all P<0.05).Cluster 3 patients had a significantly higher risk of death(log-rank P=0.022).Conclusions:Thirty-one percent of PAH patients in this study had concomitant OSA.PAH patients with significantly elevated NT-proBNP and comorbid moderate-to-severe OSA had a significantly higher risk of death compared to those with only mild or without OSA without significantly elevated NT-proBNP.Management strategies that address both PAH and OSA might be effective in improving the outcomes of these patients.

Hospitals presently confront multiple challenges, including rapid technological advancements, escalating healthcare demands, and continuously rising healthcare costs, thereby necessitating the introduction of new quality productive forces to drive high-quality hospital development. Adopting the perspective of new quality productive forces, the authors examined the transformation trend from conventional fragmented medical services towards integrated digital healthcare systems. Through the establishment of digital infrastructure characterized by big data, cloud computing, the Internet of Things, and artificial intelligence, hospitals could realize deep integration between inpatient and outpatient care, as well as seamless online and offline service delivery. Concurrently, oriented by the healthcare needs of residents, a precise and efficient " prevention-diagnosis-treatment-rehabilitation" service mode was proposed. This mode could facilitate the extension of innovation and industrial chains originating from healthcare services, expedite the translation of research outcomes into practice, and promote scientifically meticulous hospital management. Collectively, these measures could enable hospitals to develop patient-centered, comprehensive life-cycle healthcare service systems, thereby promoting the high-quality development of hospitals.

Objective:To explore the intervention effect of Shumu Peitu herb-partitioned moxibustion on clinical signs and symptoms and negative emotions of diarrhea-predominant irritable bowel syndrome (IBS-D) patients with liver-stagnation and spleen-deficiency pattern.Methods:A total of 72 patients with IBS-D of liver-stagnation and spleen-deficiency pattern treated in the Department of Gastroenterology of Nanjing Vniversity of Chinese Medicine from September 2021 to June 2022 were selected for randomized controlled trial. The patients were randomly divided into the observation group (2 cases dropped off, 34 cases in total) and control group (1 case dropped off, 35 cases in total) by random number table method. The patients in control group were treated with Tongxieyaofang (TXYF). The patients in observation group were treated with oral administration of TXYF and Shumu Peitu herb-partitioned moxibustion, and both groups were treated for 4 weeks. The clinical efficacy, Traditional Chinese Medicine (TCM) syndrome integral, IBS Quality of Life Questionnaire (IBS-QOL), IBS Symptom Severity Scale (IBS-SSS), Bristol Stool Form Scale and Hospital Anxiety and Depression Scale (HADS) were compared before and after treatment.Results:After treatment, the total effective rate of the observation group was 94.12%(32/34), which was higher than the 71.43%(25/35) in the control group, the difference was significant ( χ2 = 6.18, P<0.05). After treatment, the TCM syndrome integral in the observation group was (7.62 ± 4.08), which was lower than the (9.89 ± 4.71) in the control group, the difference was significant ( t = 2.14, P<0.05). After treatment of 3 days, the scores of quality of life in the five dimensions of dysthymia, behavior disorder, health worry, avoidance of eating and social function in the observation group were (82.44 ± 11.46), (80.25 ± 11.67), (76.23 ± 12.67), (59.80 ± 15.14) and (79.23 ± 11.59) points, which were different with the (73.57 ± 12.39), (72.35 ± 15.48), (69.76 ± 13.11), (50.00 ± 16.17) and (73.04 ± 13.11) points in the control group, the difference were significant ( t values were -3.09 - -2.08, all P<0.05). Three days after treatment, the score of IBS-SSS and Bristol fecal character in the observation group were (118.24 ± 40.64) and (5.09 ± 0.62) points, which were lower than the (146.86 ± 60.09) and (5.51 ± 0.66) points in the control group, the difference were significant ( t = 2.31 and 2.76, both P<0.05). After treatment, the score of HADS-A and HADS-D in the observation group were (6.26 ± 1.75) and (5.29 ± 1.47), which were different with the (7.26 ± 2.19) and (6.17 ± 2.11) in the control group, the difference were significant ( t = 2.08 and 2.00, both P<0.05). Conclusions:Shumu Peitu herb-partitioned moxibustion can effectively improve IBS-D patients with liver-stagnation and spleen-deficiency pattern, relieve clinical symptoms, reduce negative emotions, and improve quality of life.

Objective To study the prevalence and associated factors of loneliness in individuals with speech disability.Methods Using multi-stage stratified random cluster sampling method,170 community-residing ver-bally disabled persons were selected and administered with a general information questionnaire,one single -item loneliness self-rating question and social support scale.A total of 204 study questionnaires were distributed to the subjects;170 subjects(mean age:43.1±13.7 years)completed the survey.Results As high as 46.47% (79/170)of these verbally disabled individuals reported to feel lonely often.Females (OR=2.45),unemployment (OR=2.95), first and second degrees of disability (OR=4.35),co-existence of chronic illnesses (OR=6.50)and low utiliza-tion of social support (OR=2.58)were significantly associated with the increased risk of loneliness in persons with speech disability (P =0.002~0.046).Conclusion Loneliness is highly prevalent in individuals with speech disabili-ty.Verbally disabled persons,who are female,unemployed,severely disabled,and chronically ill and have a low use of social support,are the target population of mental health services.

Objective To investigate methods and results of endovascular treatment in TASC (Ⅱ) D-type femoral artery occlusion. Methods From January 2012 to May 2013, 26 cases (26 branches) of superficial femoral artery occlusion with endovascular treatment of TASC (Ⅱ) D-type superficial femoral artery occlusion were retrospectively reviewed. The effi-cacy was evaluated through ABI, CTA, DSA and symptoms improved. Results 26 branches were treated with endovascular methods. Technical success rate was 80.7%(21/26), including 13 branche with stent implantation, 6 branches with Silver-hawk atherectomy and 2 branches with Viabahn stent implantation. All patients were followed up for a mean period of (10.3 ± 1.2)months, primary patency rates at 6 months were 69.2%in stent group, 66.7%in Silverhawk atherectomy group and 100%in Viabahn stent group. Conclusion Endovascular treatment of TASC (Ⅱ) D-type femoral artery occlusion can lead to satisfactory short term patency rates, and Viabahn stent is the latest treatment.

ObjectiveTo summarize the results of stereotactic radiation therapy (SRT) with or without whole-brain radiotherapy (WBRT) in the treatment of multiple brain metastasis.MethodsFrom May 1995 to April 2010,totally 98 newly diagnosed multiple (2 - 13 lesions) brain metastases patients were treated in our centre.Forty-four patients were treated with SRT alone and 54 with SRT + WBRT.Dose fractionation schemes were 15 -26 Gy in 1 fraction or 24.0 -52.5 Gy in 2 - 15 fractions with 3.5 - 12.0 Gy per fraction,depending on the tumor volume,location,and history of prior irradiation.Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis.The median age of the whole group was 55 years.The survival time was calculated from the date of radiation treatment to the day of death by any cause.ResultsThe median follow-up time for the whole group was 12 months,and the follow-up rate was 100％.The median overall survival time was 13.5 months for the whole group,there was no difference between SRT alone group and SRT + WBRT group ( 13.0 months vs.13.5 months,χ2 =0.31,P =0.578 ).The Karnofsky Performance Score ( KPS) at the time of treatment ( χ2 =6.25,P =0.012 ),the interval between the diagnosis of the primary tumor and brain metastases ( χ2 =7.34,P =0.025 ) and the status of extracranial metastases ( χ2 =4.20,P =0.040) were independent prognosis factors for survival in multivariate analyses.ConclusionsStereotactic radiation therapy is an effective and alternative treatment choice for multiple brain metastases.