Objective:To investigate the risk factors associated with the development of venous thromboembolism with abdominal infection following pancreatic cancer surgery.Methods:A retrospective analysis was conducted on the clinical data of 70 patients with pancreatic cancer who underwent pancreaticoduodenectomy at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Air Force Medical University from March 2020 to August 2024, of which 31 were male and 39 were female, aged (58.5±6.8) years. Two groups were divided into two groups according to the occurrence of venous thromboembolism with abdominal infection in the postoperative period: the complication group ( n=28) and the non-complication group ( n=42). The general data, laboratory indexes and surgery-related indexes of the two groups were recorded, and logistic regression model was used to analyse the risk factors for the occurrence of venous thromboembolism with abdominal cavity infection after pancreaticoduodenectomy, and receiver operating characteristic (ROC) curve was used to assess the predictive value of the factors for the occurrence of venous thromboembolism with abdominal cavity infection after pancreatic cancer surgery. Results:Multifactorial analysis showed that the combination of diabetes mellitus ( OR=1.216, 95% CI: 1.225-1.657, P=0.035), occurrence of postoperative pancreatic fistula ( OR=1.292, 95% CI: 1.095-1.829, P=0.022), occurrence of postoperative biliary fistula ( OR=1.239, 95% CI: 1.171-2.618, P=0.005), high D-dimer ( OR=137.030, 95% CI: 3.214-5 843.128, P=0.010), prolonged operation time ( OR=1.058, 95% CI: 1.002-1.117, P=0.042), and low serum albumin ( OR=0.711, 95% CI: 0.508-0.995, P=0.046) in pancreatic cancer patients with a high risk of postoperative venous thromboembolism with the development of abdominal infection. ROC curve analysis showed that diabetes mellitus, pancreatic fistula, biliary fistula, D-dimer, duration of surgery, serum albumin, and co-prediction had certain predictive value for the occurrence of postoperative venous thromboembolism with abdominal infection after pancreatic cancer surgery, in which, the area under the curve for co-prediction in assessing the occurrence of postoperative venous thromboembolism with abdominal infection after pancreatic cancer surgery was 0.993 (95% CI: 0.982-1.000), with a sensitivity of 1.000 and a specificity of 0.929. Conclusion:Comorbid diabetes mellitus, pancreatic fistula, biliary fistula, D-dimer, prolonged duration of surgery, and serum albumin are independent risk factors for the development of postoperative venous thromboembolism with abdominal infection in patients with pancreatic cancer, all of which have diagnostic value and a high joint predictive value. The predictive value of co-prediction is relatively high.

Objective Constructing a transitional care program for critically ill children in the ICU and exploring the effects of its application on the relocation stress and caregiving abilities of parents of children to improve their caregiving experience.Methods Convenience sampling method was used to select 150 children and their families transferred from PICU to the general ward of a tertiary pediatric hospital in Shanghai from January to September 2023 as research subjects.Subjects enrolled from June to September 2023 were selected as an experimental group,and were applied with the ICU transitional care program for critically ill children.Those enrolled from January to April 2023 were selected as a control group,and received routine ICU transitional care.Family Relocation Stress Scale and Family Caregiver Task Inventory were used to evaluate children's families at 24h before,24h after,and 72h after children's transition from ICU.The incidence of unplanned readmission to ICU within 48h and adverse events were compared between 2 groups of children.Results Eventually 74 pairs in the experimental group and 75 pairs in the control group completed the study.The Family Caregiver Task Inventory scores in the experimental group were lower than that in the control group(P=0.046).Generalized estimation equation showed that,there were significant differences on the intervention effect,the time effect,and the interaction effect of the Family Relocation Stress Scale scores in 2 groups(P＜0.05).Conclusion The ICU transitional care program for critically ill children constructed in this study can effectively improve the level of migration stress and caregiving ability of parents of critically ill children,and optimize the quality of transitional care for critically ill children.

Objective To evaluate the efficacy and safety of Mirabegron combined with transcutaneous tibial nerve stimulation (TTNS) in the treatment of drug-refractory overactive bladder (OAB), so as to alleviate patients'symptoms, improve their quality of life with optimized treatment plan, and provide reference for clinical practice. Methods A retrospective analysis was conducted on 56 patients with drug-refractory OAB treated at the Department of Urology of Gansu Provincial Hospital during Jan.2023 and Dec.2024. Based on the treatment methods, the patients were divided into two groups:the TTNS group and the combined treatment group, with 28 patients in either group. The daytime urination frequency, nocturia frequency, urgency episodes, urinary incontinence, functional bladder capacity (FBC), OAB symptom scores (OABSS), and incontinence quality of life questionnaire (I-QoL) scores were collected before and after treatment. The therapeutic efficacy was evaluated using the Nimodipine method. Results After 12 weeks of treatment, the 24-hour urination indicators in both groups including daytime urination frequency, nocturia frequency, urgency episodes and FBC, as well as OABSS and I-QoL scores, showed a significant improvement compared to baseline (P<0.001). The combined treatment group exhibited fewer urgency episodes than the TTNS group [ (1.07±0.66) times/24 h vs. (1.64±0.62) times/24 h, P<0.05]. However, no statistically significant differences were observed between the two groups in other urinary parameters (P>0.05). The total effective rate in the combined treatment group was 96.43%, which was significantly higher than that in the TTNS group (82.14%, P<0.05). During treatment, one patient (3.57%) in the TTNS group experienced mild skin allergy, which recovered following symptomatic management. Conclusion The combination of TTNS and Mirabegron in drug-refractory OAB not only alleviates clinical symptoms and improves quality of life, but also shows superior efficacy in reducing urgency episodes. This approach is a safe and effective treatment option.

Medical schools in the United Kingdom are fully aware of the importance of global health education in cul-tivating future medical talents.Global health education has been integrated into medical education and with novo cur-riculum and implementation of smart teaching technology.The medical schools constantly update and improve learning outcomes of global health curriculum and achieved the goal of education reformation.Drawing on the relevant experi-ence from the U.K.,China should steadily develop global health education for medical students,strengthen the con-struction of global health courses and degree programs,enhance medical students'global health competence,and at-tach importance to the cultivation of high-level global health professionals.

ObjectiveTo assess the efficiency of a Sophora flavescens Ait (S. flavescens, Ku Shen)-soluble microneedle (SFA-MN) for improving skin lesion symptoms in mice with psoriasis.MethodsSFA-MNs were prepared using a two-mold molding process with 20% w/v polyvinylpyrrolidone and 15% w/v polyvinyl alcohol. The SFA-MNs were assessed for morphology, mechanical properties, in vitro dissolution, identification of components, and skin lesion improvement in imiquimod-induced psoriasis mice.ResultsThe SFA-MNs demonstrated good mechanical properties for efficiently penetrating the dermis, facilitating efficient drug delivery. Furthermore, they effectively inhibited mast cell levels in the dorsal lesion area of psoriasis mice and reduced the expression of the T-lymphocyte factor cluster of differentiation 3 and tumor necrosis factor-α. In addition, this system alleviated skin inflammation, splenic swelling, and thymic atrophy in the psoriasis-like mouse model. Seven major components were detected from SFA-MNs by comparison of the mass-to-nucleus ratios (m/z) of the secondary fragments N-methylcytisine, 5α, 9α-dihydroxymatrine, sophoramine, matrine, oxysophocarpine, oxymatrine, and kushenol O.ConclusionThe drug delivery strategy combining traditional herbal S. flavescens with soluble microneedle technology provides more targeted and effective immune regulation for treating psoriasis-like mice models, enabling enhanced therapeutic effects compared with the control group.

OBJECTIVE To analyze pathogens of multiple drug-resistant organism(MDRO)infection and its risk factors during the recovery period of patients with traumatic brain injury,and to construct and validate the predic-tion model for MDRO lung infection.METHODS Patients who were admitted to the Shanxi Second People's Hos-pital for traumatic brain injury(TBI)and developed hospital-acquired pneumonia(HAP)during their hospitaliza-tion between Aug.2019 and Aug.2023 were selected as the study subjects,their clinical data were retrospectively collected,and the patients were randomly divided into a modeling group(n=270)and a verification group(n=90)at a ratio of 3∶1,and they were further categorized into the MDRO infection group(148 cases)and the non-infection group(122 cases)based on whether they developed pneumonia caused by MDRO infections.Clinical data of the patients were collected for analysis,with pathogen identification performed for all patients.The risk factors for MDRO infection in TBI patients with HAP were analyzed by multivariate Logistic regression analysis,a pre-diction model for MDRO infections during the hospitalization and recovery period of TBI patients with HAP was constructed using a formula-based method,the goodness-of-fit of the model was assessed using Hosmer-Leme-show test,and its predictive ability was evaluated using receiver operating characteristic(ROC)curves.RESULTS There was no significant differences in the baseline characteristics of TBI patients with HAP between the modeling group and the verification group.The incidence of MDRO infections among TBI patients with HAP in modeling group was 54.81％(148/270),with Klebsiella pneumoniae(25.27％)being the predominant pathogen.Mechan-ical ventilation duration(OR=5.789,95％CI:2.164-15.486,P=0.001),ICU length of stay(OR=5.441,95％CI:2.153-13.751,P＜0.001),combined kidney diseases(OR=2.770,95％CI:1.321-5.812,P=0.007),duration of antibiotics use(OR=7.486,95％CI:1.928-29.059,P=0.004),occurrence of impaired consciousness(OR=5.720,95％CI:2.586-12.652,P＜0.001)and use of aminoglycoside antibiotics(OR=3.861,95％CI:1.608-9.273,P=0.003)were risk factors for MDRO infections.The Hosmer-Lemeshow for the risk prediction model showed that x2=5.013 and P=0.496.ROC curves analysis showed The area under the curve(AUC)for the modeling group by ROC curve analysis was 0.80(95％CI:0.773-0.877),with a sensitivi-ty of 83.33％and a specificity of 73.60％respectively,and the AUC for the verification group were 0.800(95％CI:0.670-0.895),with a sensitivity of 81.82％and a specificity of 77.27％respectively.CONCLUSION The prediction model constructed in this study,based on the risk factors for MDRO infection pneumonia during the re-covery period in hospitalized patients with traumatic brain injury,demonstrated high goodness-of-fit,as well as satisfactory sensitivity and specificity,and its application in clinical practice may help identify patients at high risk of MDRO infections.

OBJECTIVE To analyze pathogens of multiple drug-resistant organism(MDRO)infection and its risk factors during the recovery period of patients with traumatic brain injury,and to construct and validate the predic-tion model for MDRO lung infection.METHODS Patients who were admitted to the Shanxi Second People's Hos-pital for traumatic brain injury(TBI)and developed hospital-acquired pneumonia(HAP)during their hospitaliza-tion between Aug.2019 and Aug.2023 were selected as the study subjects,their clinical data were retrospectively collected,and the patients were randomly divided into a modeling group(n=270)and a verification group(n=90)at a ratio of 3∶1,and they were further categorized into the MDRO infection group(148 cases)and the non-infection group(122 cases)based on whether they developed pneumonia caused by MDRO infections.Clinical data of the patients were collected for analysis,with pathogen identification performed for all patients.The risk factors for MDRO infection in TBI patients with HAP were analyzed by multivariate Logistic regression analysis,a pre-diction model for MDRO infections during the hospitalization and recovery period of TBI patients with HAP was constructed using a formula-based method,the goodness-of-fit of the model was assessed using Hosmer-Leme-show test,and its predictive ability was evaluated using receiver operating characteristic(ROC)curves.RESULTS There was no significant differences in the baseline characteristics of TBI patients with HAP between the modeling group and the verification group.The incidence of MDRO infections among TBI patients with HAP in modeling group was 54.81％(148/270),with Klebsiella pneumoniae(25.27％)being the predominant pathogen.Mechan-ical ventilation duration(OR=5.789,95％CI:2.164-15.486,P=0.001),ICU length of stay(OR=5.441,95％CI:2.153-13.751,P＜0.001),combined kidney diseases(OR=2.770,95％CI:1.321-5.812,P=0.007),duration of antibiotics use(OR=7.486,95％CI:1.928-29.059,P=0.004),occurrence of impaired consciousness(OR=5.720,95％CI:2.586-12.652,P＜0.001)and use of aminoglycoside antibiotics(OR=3.861,95％CI:1.608-9.273,P=0.003)were risk factors for MDRO infections.The Hosmer-Lemeshow for the risk prediction model showed that x2=5.013 and P=0.496.ROC curves analysis showed The area under the curve(AUC)for the modeling group by ROC curve analysis was 0.80(95％CI:0.773-0.877),with a sensitivi-ty of 83.33％and a specificity of 73.60％respectively,and the AUC for the verification group were 0.800(95％CI:0.670-0.895),with a sensitivity of 81.82％and a specificity of 77.27％respectively.CONCLUSION The prediction model constructed in this study,based on the risk factors for MDRO infection pneumonia during the re-covery period in hospitalized patients with traumatic brain injury,demonstrated high goodness-of-fit,as well as satisfactory sensitivity and specificity,and its application in clinical practice may help identify patients at high risk of MDRO infections.

Objective:To investigate the risk factors associated with the development of venous thromboembolism with abdominal infection following pancreatic cancer surgery.Methods:A retrospective analysis was conducted on the clinical data of 70 patients with pancreatic cancer who underwent pancreaticoduodenectomy at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Air Force Medical University from March 2020 to August 2024, of which 31 were male and 39 were female, aged (58.5±6.8) years. Two groups were divided into two groups according to the occurrence of venous thromboembolism with abdominal infection in the postoperative period: the complication group ( n=28) and the non-complication group ( n=42). The general data, laboratory indexes and surgery-related indexes of the two groups were recorded, and logistic regression model was used to analyse the risk factors for the occurrence of venous thromboembolism with abdominal cavity infection after pancreaticoduodenectomy, and receiver operating characteristic (ROC) curve was used to assess the predictive value of the factors for the occurrence of venous thromboembolism with abdominal cavity infection after pancreatic cancer surgery. Results:Multifactorial analysis showed that the combination of diabetes mellitus ( OR=1.216, 95% CI: 1.225-1.657, P=0.035), occurrence of postoperative pancreatic fistula ( OR=1.292, 95% CI: 1.095-1.829, P=0.022), occurrence of postoperative biliary fistula ( OR=1.239, 95% CI: 1.171-2.618, P=0.005), high D-dimer ( OR=137.030, 95% CI: 3.214-5 843.128, P=0.010), prolonged operation time ( OR=1.058, 95% CI: 1.002-1.117, P=0.042), and low serum albumin ( OR=0.711, 95% CI: 0.508-0.995, P=0.046) in pancreatic cancer patients with a high risk of postoperative venous thromboembolism with the development of abdominal infection. ROC curve analysis showed that diabetes mellitus, pancreatic fistula, biliary fistula, D-dimer, duration of surgery, serum albumin, and co-prediction had certain predictive value for the occurrence of postoperative venous thromboembolism with abdominal infection after pancreatic cancer surgery, in which, the area under the curve for co-prediction in assessing the occurrence of postoperative venous thromboembolism with abdominal infection after pancreatic cancer surgery was 0.993 (95% CI: 0.982-1.000), with a sensitivity of 1.000 and a specificity of 0.929. Conclusion:Comorbid diabetes mellitus, pancreatic fistula, biliary fistula, D-dimer, prolonged duration of surgery, and serum albumin are independent risk factors for the development of postoperative venous thromboembolism with abdominal infection in patients with pancreatic cancer, all of which have diagnostic value and a high joint predictive value. The predictive value of co-prediction is relatively high.

Objective Constructing a transitional care program for critically ill children in the ICU and exploring the effects of its application on the relocation stress and caregiving abilities of parents of children to improve their caregiving experience.Methods Convenience sampling method was used to select 150 children and their families transferred from PICU to the general ward of a tertiary pediatric hospital in Shanghai from January to September 2023 as research subjects.Subjects enrolled from June to September 2023 were selected as an experimental group,and were applied with the ICU transitional care program for critically ill children.Those enrolled from January to April 2023 were selected as a control group,and received routine ICU transitional care.Family Relocation Stress Scale and Family Caregiver Task Inventory were used to evaluate children's families at 24h before,24h after,and 72h after children's transition from ICU.The incidence of unplanned readmission to ICU within 48h and adverse events were compared between 2 groups of children.Results Eventually 74 pairs in the experimental group and 75 pairs in the control group completed the study.The Family Caregiver Task Inventory scores in the experimental group were lower than that in the control group(P=0.046).Generalized estimation equation showed that,there were significant differences on the intervention effect,the time effect,and the interaction effect of the Family Relocation Stress Scale scores in 2 groups(P＜0.05).Conclusion The ICU transitional care program for critically ill children constructed in this study can effectively improve the level of migration stress and caregiving ability of parents of critically ill children,and optimize the quality of transitional care for critically ill children.

Objective:To evaluate the titanium cable tensioning ring fixation in the treatment of distal tibiofibular syndesmosis (DTS) injury.Methods:A retrospective study was conducted to analyze the 108 patients with DTS injury who had undergone surgical treatment from January 2021 to January 2023 at Department of Traumatology, The Second Hospital of Tangshan. There were 68 males and 40 females with an age of (40.1±13.0) years. According to the fixation methods used, the patients were divided into a Titanium cable group and an Endobutton plate group. The Titanium cable group of 53 cases was subjected to fixation with a titanium cable tensioning ring while the Endobutton plate group of 55 cases to fixation with an Endobutton plate. The 2 groups were compared in terms of the anterior and posterior tibiofibular spaces on the transverse CT images at 1 week and 12 months postoperatively, as well as the Baird-Jackson scores of ankle joint function at 6 and 12 months postoperatively.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P > 0.05). There was no statistically significant difference in the comparison of the anterior and posterior tibiofibular spaces on the transverse CT images at 1 week postoperatively ( P > 0.05). The anterior and posterior tibiofibular spaces on the transverse CT images at 12 months postoperatively in the Endobutton plate group [(3.60±0.59) mm and 4.58 (4.38, 4.89) mm] were significantly greater than those in the Titanium cable group [(3.34±0.53) mm and 4.36 (4.13, 4.67) mm] ( P < 0.05). There was no statistically significant difference in the Baird-Jackson ankle function scores at 6 and 12 months postoperatively between the 2 groups ( P > 0.05). Conclusions:In the treatment of DTS injury, fixation with titanium cable tensioning ring can achieve as good therapeutic effects as fixation with Endobutton plate. However, the former may have certain advantages in surgical operation and long-term reduction loss.