Objective To investigate the effect of health failure mode and effect analysis(HFMEA)in optimizing the management process of postoperative diabetes insipidus in children undergoing neurosurgery.Methods Based on HFMEA,a management flowchart for postoperative diabetes insipidus in children undergoing neurosurgery was created.Brainstorming was adopted to identify failure modes in the workflow,analyze risk factors,and develop improvement measures,thereby refining the management flowchart.The amelioration and prognosis of diabetes insipidus in these children before(October 2022 to November 2023)and after(January 2024 to February 2025)implementation of the management flowchart were compared.Results The HFMEA-based management process for postoperative diabetes insipidus in children undergoing neurosurgery alleviated the symptoms of diabetes insipidus regarding the number of diabetes insipidus in the pediatric intensive care unit(P=0.006),the average daily urine output in the pediatric intensive care unit(P=0.001),the proportion of electrolyte abnormalities at discharge/transfer(P=0.037),the duration of mechanical ventilation(P=0.007),and the length of stay in the intensive care unit(P=0.001).Conclusion The HFMEA-based management process for postoperative diabetes insipidus in children undergoing neurosurgery is beneficial to the optimization of the management process,the alleviation of postoperative diabetes insipidus,and the improvement of prognosis in these children.
Humans ; Diabetes Insipidus/etiology* ; Neurosurgical Procedures/adverse effects* ; Child ; Postoperative Complications/therapy* ; Healthcare Failure Mode and Effect Analysis ; Intensive Care Units, Pediatric ; Risk Factors

Molecularly imprinted polymers(MIPs)of colchicine(COL)were prepared by precipitation polymerization with COL as template,methacrylic acid(MAA)as monomer,ethylene glycol dimethacrylate(EGDMA)as crosslinking agent,azobisisobutyronitrile(AIBN)as initiator and chloroform as porogen.The basic structure of the prepared MIPs was characterized by scanning electron microscopy(SEM),transmission electron microscopy(TEM)and Fourier transform infrared(FT-IR)spectrometry,and the adsorption properties of MIPs were evaluated by kinetic adsorption,isothermal adsorption and selective adsorption experiments.The results indicated that the prepared MIPs had uniform particles size,with a maximum adsorption capacity of 62.61 mg/g for COL and an imprinting factor of 3.74,and was suitable for sample pretreatment in determination of COL blood concentration,enabling the enrichment and separation of trace or even ultra-trace target components,thereby improving analytical capabilities.

Objective To investigate the correlation of monocyte count(MONO)to high density lipopro-tein-cholesterol(HDL-C)ratio(MHR)and systemic immune-inflammation index(SII)with diabetic retinop-athy(DR).Methods Patients with type 2 diabetes mellitus(T2DM)admitted to the hospital from June 2020 to May 2023 were selected as the research objects.According to the presence or absence of DR,the patients were divided into non-retinopathy group(NDR group)and DR Group.The differences in basic information,blood routine,and biochemical indexes between the two groups were analyzed,and the MHR and SII were cal-culated.Multivariate Logistic regression was used to analyze the risk factors for DR.Spearman correlation a-nalysis was used to analyze the correlation between risk factors and DR.The receiver operating characteristic(ROC)curve was used to evaluate the value of MHR and SII in predicting DR in T2DM patients.Results A total of 291 T2DM patients were enrolled,including 135 patients in the NDR group and 156 patients in the DR group.Compared with the NDR group,duration of diabetes was significantly prolonged(P<0.05),glycosy-lated hemoglobin(HbA1c),creatinine,fasting plasma glucose(FPG),total cholesterol(TC),platelet count(PLT),MHR and SII were increased(P<0.05),and high density lipoprotein-cholesterol(HDL-C)was de-creased(P<0.05)in the DR Group.Spearman correlation analysis showed that DR was positively correlated with duration of diabetes,FPG,HbA1c,PLT,MHR and SII(P<0.05),and negatively correlated with HDL-C(P<0.05).Multivariate Logistic regression analysis showed that gender(OR=0.151,95%CI 0.052-0.432,P<0.001),history of heavy drinking(OR=7.199,95%CI 2.845-18.216,P<0.001),duration of di-abetes(OR=1.570,95%CI 1.354-1.821,P<0.001),HbA1c(OR=1.218,95%CI 1.013-1.464,P=0.036),MHR(OR=1.054,95%CI 1.028-1.080,P<0.001)and SII(OR=1.002,95%CI 1.001-1.003,P=0.002)were independent influencing factors for DR patients.ROC curve analysis showed that the area un-der the curve(AUC)of MHR and SII in predicting the development of T2DM to DR was 0.696 and 0.567,re-spectively.The AUC of MHR and SII combined in predicting DR was 0.702.Conclusion MHR and SII are closely related to the incidence of DR,and both have certain predictive value for DR,and the predictive value of the combined of MHR and SII is higher.

Objective:To investigate the current status of innovative behavior among male nurses in the Anhui Province, conduct potential profile analysis and explore its influencing factors, providing reference for formulating intervention stratigies to enhance innovative behavior among male nurses.Methods:From January to February 2022, a stratified convenience sampling method was used to select clinical male nurses as the participants from five tertiary and first-class comprehensive hospitals in Anhui Province. A cross-sectional survey was conducted using the general demoraphic questionnaire, Nurse Innovation Behavior Scale, Authentic Leadership Scale, and Psychological Capital Questionnaire. Potential profile analysis was conducted on the innovative behavior characteristics of male nurses, and single factor analysis and Logistic regression analysis were used to test the differences in male nurses' innovative behavior characteristics.Results:Among the 220 male nurses, 107 (48.64%) were under the age of 30, accounting for the largest proportion. The innovative behavior score of participants was (38.83 ± 7.80) points, which could be divided into three categories: low-level silent type (27.3%, 60/220), medium-level conservative type (44.5%, 98/220), and high-level active type (28.2%, 62/220). Compared to the low-level silent type, male nurses with higher levels of perceived authentic leadership were more likely to belong to the medium-level conservative type ( OR = 1.055, 95% CI 1.019 - 1.093, P<0.05) and the high-level active type ( OR = 1.124, 95% CI 1.066 - 1.184, P<0.01). The higher the level of psychological capital, the greater the probability that male nurses belong to the medium-level conservative type ( OR = 1.088, 95% CI 1.050 - 1.128, P<0.01) and the high-level active type ( OR = 1.273, 95% CI 1.196 - 1.355, P<0.01). Conclusions:The innovative behavior of male nurses in Anhui Province was at a medium level and had obvious classification characteristics. Nursing managers should focus on low-level silent type and medium-level conservative type male nurses, and adopt targeted interventions and support based on different category characteristics to improve their innovation behavior capacities in clinical settings.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

OBJECTIVE: To investigate the clinical characteristics, curative effect and prognostic factors of patients with multiple myeloma (MM) complicated with light chain myocardial amyloidosis (AL-CA). METHODS: The data of 38 patients diagnosed with MM complicated with AL-CA in our hospital from January 2018 to December 2023 were retrospectively analyzed, and the data were comprehensively screened by multiple methods such as positive two-dimensional spot tracking echocardiography (2D-STE). Survival analysis was performed using the Kaplan-Meier method. Cox regression models were used to screen for independent prognostic factors. RESULTS: Among the 38 MM patients with AL-CA, 23 were male and 15 were female, with a median age of 60(50,75) years. The 1-year survival rate was 71.05%. Patients who underwent transplantation had significantly better survival outcomes than those who did not (P < 0.01). Additionally, the median survival time of patients with all-negative FISH results at the first visit was statistically different compared to patients with other mutations (P < 0.05). Multivariate Cox regression analysis showed that all negative FISH results at the first visit and the absence of autologous hematopoietic stem cell transplantation (ASCT) were not independent risk factor for the prognosis of patients with MM and AL-CA (P >0.05). CONCLUSION ASCT may improve the prognosis of MM patients with AL-CA, and negative FISH results may indicate poor prognosis, but the results still need to be verified by larger samples.
Humans ; Multiple Myeloma/complications* ; Retrospective Studies ; Aged ; Female ; Male ; Middle Aged ; Prognosis ; Hematopoietic Stem Cell Transplantation ; Amyloidosis/complications* ; Survival Rate ; Proportional Hazards Models

OBJECTIVE: To explore the effect of bear bile powder (BBP) on acute lung injury (ALI) and the underlying mechanism. METHODS: The chemical constituents of BBP were analyzed by ultra-high-pressure liquid chromatography-mass spectrometry (UPLC-MS). After 7 days of adaptive feeding, 50 mice were randomly divided into 5 groups by a random number table (n=10): normal control (NC), lipopolysaccharide (LPS), dexamethasone (Dex), low-, and high-dose BBP groups. The dosing cycle was 9 days. On the 12th and 14th days, 20 µL of Staphylococcus aureus solution (bacterial concentration of 1 × 10^-7 CFU/mL) was given by nasal drip after 1 h of intragastric administration, and the mice in the NC group was given the same dose of phosphated buffered saline (PBS) solution. On the 16th day, after 1 h intragastric administration, 100 µL of LPS solution (1 mg/mL) was given by tracheal intubation, and the same dose of PBS solution was given to the NC group. Lung tissue was obtained to measure the myeloperoxidase (MPO) activity, the lung wet/dry weight ratio and expressions of CD14 and other related proteins. The lower lobe of the right lung was obtained for pathological examination. The concentrations of inflammatory cytokines including interleukin (IL)-6, tumour necrosis factor α (TNF-α ) and IL-1β in the bronchoalveolar lavage fluid (BALF) were detected by enzyme linked immunosorbent assay, and the number of neutrophils was counted. The colonic contents of the mice were analyzed by 16 sRNA technique and the contents of short-chain fatty acids (SCFAs) were measured by gas chromatograph-mass spectrometer (GC-MS). RESULTS: UPLC-MS revealed that the chemical components of BBP samples were mainly tauroursodeoxycholic acid and taurochenodeoxycholic acid sodium salt. BBP reduced the activity of MPO, concentrations of inflammatory cytokines, and inhibited the expression of CD14 protein, thus suppressing the activation of NF-κB pathway (P<0.05). The lung histopathological results indicated that BBP significantly reduced the degree of neutrophil infiltration, cell shedding, necrosis, and alveolar cavity depression. Moreover, BBP effectively regulated the composition of the intestinal microflora and increased the production of SCFAs, which contributed to its treatment effect (P<0.05). CONCLUSIONS BBP alleviates lung injury in ALI mouse through inhibiting activation of NF-κB pathway and decreasing expression of CD14 protein. BBP may promote recovery of ALI by improving the structure of intestinal flora and enhancing metabolic function of intestinal flora.
Animals ; Acute Lung Injury/pathology* ; Lipopolysaccharides ; Ursidae ; Gastrointestinal Microbiome/drug effects* ; Bile/chemistry* ; Lipopolysaccharide Receptors/metabolism* ; Powders ; Male ; Lung/drug effects* ; Mice ; Peroxidase/metabolism* ; Signal Transduction/drug effects* ; Cytokines/metabolism*

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BACKGROUND: The use of inserted sham acupuncture as a placebo in randomized controlled trials (RCTs) is controversial, because it may produce specific effects that cause an underestimation of the effect of acupuncture treatment. OBJECTIVE: This systematic survey investigates the magnitude of insert-specific effects of sham acupuncture and whether they affect the estimation of acupuncture treatment effects. SEARCH STRATEGY: PubMed, Embase and Cochrane Central Register of Controlled Trials were searched to identify acupuncture RCTs from their inception until December 2022. INCLUSION CRITERIA: RCTs that evaluated the effects of acupuncture compared to sham acupuncture and no treatment. DATA EXTRACTION AND ANALYSIS: The total effect measured for an acupuncture treatment group in RCTs were divided into three components, including the natural history and/or regression to the mean effect (controlled for no-treatment group), the placebo effect, and the specific effect of acupuncture. The first two constituted the contextual effect of acupuncture, which is mimicked by a sham acupuncture treatment group. The proportion of acupuncture total effect size was considered to be 1. The proportion of natural history and/or regression to the mean effect (PNE) and proportional contextual effect (PCE) of included RCTs were pooled using meta-analyses with a random-effect model. The proportion of acupuncture placebo effect was the difference between PCE and PNE in RCTs with non-inserted sham acupuncture. The proportion of insert-specific effect of sham acupuncture (PIES) was obtained by subtracting the proportion of acupuncture placebo effect and PNE from PCE in RCTs with inserted sham acupuncture. The impact of PIES on the estimation of acupuncture's treatment effect was evaluated by quantifying the percentage of RCTs that the effect of outcome changed from no statistical difference to statistical difference after removing PIES in the included studies, and the impact of PIES was externally validated in other acupuncture RCTs with an inserted sham acupuncture group that were not used to calculate PIES. RESULTS: This analysis included 32 studies with 5492 patients. The overall PNE was 0.335 (95% confidence interval [CI], 0.255-0.415) and the PCE of acupuncture was 0.639 (95% CI, 0.567-0.710) of acupuncture's total effect. The proportional contribution of the placebo effect to acupuncture's total effect was 0.191, and the PIES was 0.189. When we modeled the exclusion of the insert-specific effect of sham acupuncture, the acupuncture treatment effect changed from no difference to a significant difference in 45.45% of the included RCTs, and in 40.91% of the external validated RCTs. CONCLUSION The insert-specific effect of sham acupuncture in RCTs represents 18.90% of acupuncture's total effect and significantly affects the evaluation of the acupuncture treatment effect. More than 40% of RCTs that used inserted sham acupuncture would draw different conclusions if the PIES had been controlled for. Considering the impact of the insert-specific effect of sham acupuncture, caution should be taken when using inserted sham acupuncture placebos in RCTs. Please cite this article as: Luo XC, Liu JL, Yao MH, Chen YM, Fan AY, Liang FR, Zhao JP, Zhao L, Zhou X, Zhong XY, Yang JH, Li B, Zhang Y, Sun X, Li L. Specific effect of inserted sham acupuncture and its impact on the estimation of acupuncture treatment effect in randomized controlled trials: A systematic survey. J Integr Med. 2025; 23(6):630-640.
Acupuncture Therapy/methods* ; Humans ; Randomized Controlled Trials as Topic ; Placebo Effect ; Placebos ; Treatment Outcome