Objective:To explore the correlation between Chinese visceral adiposity index (CVAI) and metabolic associated fatty liver disease (MAFLD) so as to evaluate its predictive value for MAFLD.Methods:Six hundred and thirteen cases admitted to the Department of Gastroenterology, Zhongshan Hospital Affiliated to Dalian University from June 2022 to August 2023 were selected and divided into the MAFLD group ( n=312) and the non-MAFLD group ( n=301) according to the diagnostic criteria of MAFLD. The clinical data differences between the two groups were compared. The MAFLD group was divided into a mild MAFLD group ( n=243) and a moderate to severe MAFLD group ( n=69) according to the liver/spleen CT value. The differences in body fat indices such as CVAI, visceral fat index (VAI), and visceral fat area (VFA) were compared between subjects with different degrees of MAFLD. The Spearman test was used to analyze the correlation between CVAI, VAI, and various clinical indicators. The subjects were divided into groups (Q1-Q4) according to the quartile levels of CVAI and VAI, and the distribution of MAFLD conditions among the groups was compared. Logistic regression analysis was used to determine the occurrence risk of MAFLD at different CVAI and VAI levels. The receiver operating characteristic curve was drawn. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the predictive value of CVAI, VAI, VFA, waist circumference, and body mass index for MAFLD. The DeLong test was used to compare the differences in the AUC of each predictive index. Results:The prevalence of hypertension and type 2 diabetes mellitus, and the levels of systolic blood pressure, diastolic blood pressure, CVAI, VAI, VFA, subcutaneous fat area, waist circumference, body mass index, total cholesterol, triglycerides, low-density lipoprotein cholesterol, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and serum uric acid were higher in the MAFLD group than the non-MAFLD group ( P<0.05), while the level of high-density lipoprotein cholesterol was lower than the non-MAFLD group ( P<0.001). The levels of CVAI, VAI, VFA, waist circumference, and body mass index were higher in the mild and the moderate to severe MAFLD group than those in the non-MAFLD group ( P<0.001). The detection rate of MAFLD gradually increased( χ2=176.953, 133.659, P<0.001) with the increase of CVAI and VAI levels. Correlation analysis showed that CVAI was positively correlated with VFA ( r=0.755, P<0.001) and the homeostasis model assessment of insulin resistance ( r=0.579, P<0.001). Multivariate logistic regression analysis showed that after adjusting for various risk factors, the risk of MAFLD in the Q4 group of the CVAI subgroup was still 7.159 times that of the Q1 group (95% CI:3.126-16.392, P<0.001), and the risk of MAFLD in the Q4 group of the VAI subgroup was still 4.667 times that of the Q1 group (95% CI: 2.187-9.962, P<0.001). The receiver operating characteristic curve results showed that the AUC of CVAI for predicting MAFLD was similar to that of VFA (0.822 vs. 0.826), and higher than that of VAI (AUC 0.772), waist circumference (AUC 0.796), and body mass index (AUC 0.755). The optimal critical value of CVAI for predicting the risk of MAFLD was 125.50, with sensitivity and specificity at 70.5% and 79.1%, respectively. Conclusion:The patient's risk of MAFLD increases with the rise of CVAI level, and CVAI has a favorable predictive value for the occurrence of MAFLD.

Objective:To explore the correlation between Chinese visceral adiposity index (CVAI) and metabolic associated fatty liver disease (MAFLD) so as to evaluate its predictive value for MAFLD.Methods:Six hundred and thirteen cases admitted to the Department of Gastroenterology, Zhongshan Hospital Affiliated to Dalian University from June 2022 to August 2023 were selected and divided into the MAFLD group ( n=312) and the non-MAFLD group ( n=301) according to the diagnostic criteria of MAFLD. The clinical data differences between the two groups were compared. The MAFLD group was divided into a mild MAFLD group ( n=243) and a moderate to severe MAFLD group ( n=69) according to the liver/spleen CT value. The differences in body fat indices such as CVAI, visceral fat index (VAI), and visceral fat area (VFA) were compared between subjects with different degrees of MAFLD. The Spearman test was used to analyze the correlation between CVAI, VAI, and various clinical indicators. The subjects were divided into groups (Q1-Q4) according to the quartile levels of CVAI and VAI, and the distribution of MAFLD conditions among the groups was compared. Logistic regression analysis was used to determine the occurrence risk of MAFLD at different CVAI and VAI levels. The receiver operating characteristic curve was drawn. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the predictive value of CVAI, VAI, VFA, waist circumference, and body mass index for MAFLD. The DeLong test was used to compare the differences in the AUC of each predictive index. Results:The prevalence of hypertension and type 2 diabetes mellitus, and the levels of systolic blood pressure, diastolic blood pressure, CVAI, VAI, VFA, subcutaneous fat area, waist circumference, body mass index, total cholesterol, triglycerides, low-density lipoprotein cholesterol, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and serum uric acid were higher in the MAFLD group than the non-MAFLD group ( P<0.05), while the level of high-density lipoprotein cholesterol was lower than the non-MAFLD group ( P<0.001). The levels of CVAI, VAI, VFA, waist circumference, and body mass index were higher in the mild and the moderate to severe MAFLD group than those in the non-MAFLD group ( P<0.001). The detection rate of MAFLD gradually increased( χ2=176.953, 133.659, P<0.001) with the increase of CVAI and VAI levels. Correlation analysis showed that CVAI was positively correlated with VFA ( r=0.755, P<0.001) and the homeostasis model assessment of insulin resistance ( r=0.579, P<0.001). Multivariate logistic regression analysis showed that after adjusting for various risk factors, the risk of MAFLD in the Q4 group of the CVAI subgroup was still 7.159 times that of the Q1 group (95% CI:3.126-16.392, P<0.001), and the risk of MAFLD in the Q4 group of the VAI subgroup was still 4.667 times that of the Q1 group (95% CI: 2.187-9.962, P<0.001). The receiver operating characteristic curve results showed that the AUC of CVAI for predicting MAFLD was similar to that of VFA (0.822 vs. 0.826), and higher than that of VAI (AUC 0.772), waist circumference (AUC 0.796), and body mass index (AUC 0.755). The optimal critical value of CVAI for predicting the risk of MAFLD was 125.50, with sensitivity and specificity at 70.5% and 79.1%, respectively. Conclusion:The patient's risk of MAFLD increases with the rise of CVAI level, and CVAI has a favorable predictive value for the occurrence of MAFLD.

Objective To investigate the correlation between angiopoietin-2(Ang-2)and intestinal fatty acid binding protein(I-FABP)levels and the prognosis of acute myocardial infarction(AMI)with cardiac shock(CS).Methods A total of 198 patients with AMI admitted to Huzhou Central Hospital from July 2017 to July 2019 were selected as study objects,and were divided into CS group(n=93)and non-CS group(n=105)according to whether CS occurred during the hospital period,and 65 normal volunteers admitted for physical examination during the same period were included in control group.Patients in CS group were divided into survival group(n=50)and death group(n=43)according to their survival at 28 days.Serum Ang-2 and I-FABP levels of all subjects were detected,and Cox regression analysis was used to analyze the factors affecting the poor prognosis of AMI with CS.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of Ang-2 and I-FABP in AMI with CS.Results Serum Ang-2 and I-FABP levels in CS group were significantly higher than those in non-CS group and control group(P<0.05),and serum Ang-2 and I-FABP levels in non-CS group were significantly higher than those in control group(P<0.05).Serum Ang-2,I-FABP levels and proportion of diabetes in death group were significantly higher than those in survival group(P<0.05).Cox regression analysis showed that diabetes,Ang-2 and I-FABP levels were independent factors affecting the prognosis of AMI with CS(P<0.05).ROC curve showed that the area under the curve of Ang-2 and I-FABP combined to predict the prognosis of AMI with CS was 0.819,sensitivity was 81.4%,specificity was 80.0%.Conclusion Serum Ang-2 and I-FABP levels were elevated in patients with AMI with CS,which were potential biological indicators to predict the prognosis of patients.

Objective:To investigate the effect of telephone follow-up-based pharmaceutical care on medication compliance and safety in discharged patients with type 2 diabetes mellitus.Methods:Type 2 diabetes mellitus patients, who were discharged from Beijing Tongren Hospital, Capital Medical University from January 2019 to December 2019 and with hemoglobin A1c (HbA1c) <9% during hospitalization were enrolled. Patients were divided into routine follow-up group and telephone follow-up group according to the post-discharge follow-up method. Patients in the routine follow-up group received routine pharmaceutical care and were followed up for 6 months after discharge, including outpatient follow-up once every 3 months and HbA1c test at the 6th month. On this basis, patients in the telephone follow-up group received pharmaceutical care by clinical pharmacists using telephone follow-up method, which was performed once every 2 weeks for the first 3 months after discharge and once a month for the next 3 months. The clinical pharmacists established follow-up registration files for patients in the 2 groups to record the condition of the patients on discharge and results of each follow-up. Scores of the "Diabetes Self-Management Scale (Chinese version)" score (DSMQ score, with a total score of 48 points, the higher the score, the better the self-management ability of the patient), "Chinese Version Morisky Medication Adherence Scale-8" score (Morisky score, with a total score of 8 points, regarding 6 to 8 points as good compliance), and blood glucose control results (evaluation index is HbA1c level, HbA1c <7.0% was used as the standard to calculate the compliance rate) 6 months after discharge and the incidences of adverse drug events during the follow-up period in patients between the 2 groups were compared.Results:A total of 95 patients were enrolled in the analysis, including 48 in the telephone follow-up group and 47 in the routine follow-up group. Differences in gender and age distribution, body mass index, DSMQ score, and HbA1c level and compliance rate on discharge in patients in the 2 groups were not statistically significant (all P>0.05). Six months after discharge, both the DSMQ score and Morishy score in the telephone follow-up group were higher than those in the routine follow-up group [ (38.1±4.4) vs. (34.3±4.1) points, P<0.001; (6.5±1.2) vs. (5.7±1.0) points, P<0.001]; the proportion of patients with good medication compliance in the telephone follow-up group were higher than those in the routine follow-up group [81.3% (39/48) vs. 40.4% (19/47) , P=0.031]; the HbA1c level was lower and the HbA1c compliance rate was higher in the telephone follow-up group than those in the routine follow-up group[(6.2±1.2)% vs. (6.7±1.4)%, P=0.042; 72.9% vs. 51.1%, P=0.028]; the incidence of adverse drug events in the telephone follow-up group was lower than that in the routine follow-up group [6.2% (3/48) vs. 25.5% (12/47), P=0.010]. Adverse drug events occurred in patients mainly included hypoglycemia, fatty induration or infection at the insulin injection site, and gastrointestinal reactions. Conclusion:Telephone follow-up-based pharmaceutical care can effectively improve the self-management ability of patients with type 2 diabetes after discharge, help patients maintain good medication compliance, thereby improving the blood glucose control effects and to a certain extent reducing the occurrence of adverse drug events.

Objective:To investigate the effect of telephone follow-up-based pharmaceutical care on medication compliance and safety in discharged patients with type 2 diabetes mellitus.Methods:Type 2 diabetes mellitus patients, who were discharged from Beijing Tongren Hospital, Capital Medical University from January 2019 to December 2019 and with hemoglobin A1c (HbA1c) <9% during hospitalization were enrolled. Patients were divided into routine follow-up group and telephone follow-up group according to the post-discharge follow-up method. Patients in the routine follow-up group received routine pharmaceutical care and were followed up for 6 months after discharge, including outpatient follow-up once every 3 months and HbA1c test at the 6th month. On this basis, patients in the telephone follow-up group received pharmaceutical care by clinical pharmacists using telephone follow-up method, which was performed once every 2 weeks for the first 3 months after discharge and once a month for the next 3 months. The clinical pharmacists established follow-up registration files for patients in the 2 groups to record the condition of the patients on discharge and results of each follow-up. Scores of the "Diabetes Self-Management Scale (Chinese version)" score (DSMQ score, with a total score of 48 points, the higher the score, the better the self-management ability of the patient), "Chinese Version Morisky Medication Adherence Scale-8" score (Morisky score, with a total score of 8 points, regarding 6 to 8 points as good compliance), and blood glucose control results (evaluation index is HbA1c level, HbA1c <7.0% was used as the standard to calculate the compliance rate) 6 months after discharge and the incidences of adverse drug events during the follow-up period in patients between the 2 groups were compared.Results:A total of 95 patients were enrolled in the analysis, including 48 in the telephone follow-up group and 47 in the routine follow-up group. Differences in gender and age distribution, body mass index, DSMQ score, and HbA1c level and compliance rate on discharge in patients in the 2 groups were not statistically significant (all P>0.05). Six months after discharge, both the DSMQ score and Morishy score in the telephone follow-up group were higher than those in the routine follow-up group [ (38.1±4.4) vs. (34.3±4.1) points, P<0.001; (6.5±1.2) vs. (5.7±1.0) points, P<0.001]; the proportion of patients with good medication compliance in the telephone follow-up group were higher than those in the routine follow-up group [81.3% (39/48) vs. 40.4% (19/47) , P=0.031]; the HbA1c level was lower and the HbA1c compliance rate was higher in the telephone follow-up group than those in the routine follow-up group[(6.2±1.2)% vs. (6.7±1.4)%, P=0.042; 72.9% vs. 51.1%, P=0.028]; the incidence of adverse drug events in the telephone follow-up group was lower than that in the routine follow-up group [6.2% (3/48) vs. 25.5% (12/47), P=0.010]. Adverse drug events occurred in patients mainly included hypoglycemia, fatty induration or infection at the insulin injection site, and gastrointestinal reactions. Conclusion:Telephone follow-up-based pharmaceutical care can effectively improve the self-management ability of patients with type 2 diabetes after discharge, help patients maintain good medication compliance, thereby improving the blood glucose control effects and to a certain extent reducing the occurrence of adverse drug events.

Objective To investigate the influence of inclusive leadership on organizational performance of nurses and to test the mediating role of empowerment behavior. Methods From November to December 2016, 293 nurses from 2 public hospitals in Harbin were investigated with Inclusive Leadership Scale, Empowerment Behavior Scale and Team Performance Scale. A total of 293 questionnaires were distributed and 251 questionnaires were effectively recovered. Descriptive statistics, Pearson correlation analysis and multiple linear hierarchical regression analysis were performed to analyze and process data. Results The Score of Inclusive Leadership Scale, Empowerment Behavior Scale and Team Performance Scale was (5.28±1.184), (5.25±1.216) and (5.71±1.233) respectively. Inclusive leadership had a positive correlation with empowerment behavior and organizational performance of nurses (r=0.742,0.605;P＜0.05). In addition, there was a positive correlation between empowerment behavior and organizational performance of nursing staff (r=0.615,P＜0.05). Multivariate linear hierarchical regression analysis showed that inclusive leadership had a positive predictive effect on empowerment behavior and organizational performance, and empowerment behavior of nurses partially mediated between them. Conclusions Inclusive leadership can enhance subordinate nurses' high level of empowerment awareness, thereby directly or indirectly improving nursing organization performance.

Objective To explore the effects of inclusive leadership on affective commitment of nurses and to test the mediating effect of leader-member exchange. Methods From November 2016 to December 2016, we investigated 293 nurses from two Class Ⅲ Grade A governmental hospitals of Harbin with the Inclusive Leadership Scale, Leader-member Exchange Scale and Affective Commitment Scale. Pearson correlation analysis and multiple hierarchical linear regression analysis were used to test the correlations and mediating effect among the variables. A total of 293 questionnaires were sent out and 251 valid questionnaires retained finally. Results Among 251 nurses, the scores of inclusive leadership scale, leader-member exchange scale and affective commitment scale were (5.283±1.184), (5.216±1.139) and (4.902±1.061) respectively. Pearson correlation analysis showed that inclusive leadership had positive correlations with the leader-member exchange (r=0.771,P＜ 0.01) and affective commitment (r=0.537,P＜ 0.01);leader-member exchange had a positive correlation with affective commitment (r=0.543,P＜ 0.01). Multiple hierarchical linear regression analysis indicated that inclusive leadership had positive effects on leader-member exchange and affective commitment of nurses;leader-member exchange played a partial mediating role between them. Conclusions As a whole, the inclusiveness of nursing managers on nurses is in the upper level and the leader-member exchange of nurses has a high level. Inclusive leadership has positive correlations with the leader-member exchange and affective commitment of nurses. Nursing managers should lead nurses to contribute their wisdoms with the manner of inclusive leadership so as to provide the high quality of nursing service.

OBJECTIVETo analyze factors relevant to revisional tympanomastoid surgery for chronic otitis media(COM).

METHODSThe clinical data of 159 patients (159 ears), who exhibited either wet ear or relapsed after the initial operation, and were subjected to revisional tympanomastoid surgery, were retrospectively analyzed in this study. Of those 159 consecutive patients, 85 were males and 74 were females, aged 11-64 years, with a median age of 36 years old. The situations in terms of intra-operative findings, surgical procedures, change dressing post-operation, dry ear time, and the improvement of aural ability during the second operation, were recorded and analyzed.

RESULTSThe second surgery found that, of those 159 patients underwent the re-operation, 67 presented with cholesteatoma and 92 had no cholesteatoma. In addition, the inadequate skeletonization and insufficient opening for mastoid cavity accounted for 70.4% (112/159) of all previous operations, the external auditory canal stenosis for 98.7% (157/159), the high facial ridge leading to insufficient drainage for 61.0% (97/159), the lesion in tympanic ostium of Eustachian tube for 34.6% (55/159), the insufficient drainage due to inappropriate post-operating dressing for 5.0% (8/159), the postauricular incision for 30.8% (49/159), and the endaural incision for 69.2% (110/159). As for the re-operation of the canal wall down mastoidectomy, tympanoplasty plus plastic repairing of cavity of concha were performed in 94 cases, the modified Bondy plus plastic repairing of cavity of concha in four cases, the radical mastoidectomy plus plastic repairing of cavity of concha in 59 cases, and the simple cleaning for mastoid cavity in two cases. Since one to two weeks after the revisional operations, the post-operating dressing was performed with aid of microscopy once a week on average. The average dry ear time ranged from 2 to 6 weeks (median=3 weeks). During a period of 6-93 months for the follow-up, all patients presented with dry ears. The epithelialization of the operating cavity was well and the tympanic membranes were integrity. Neither granulation tissue nor cholesteatoma was found to reoccur. Both pure tone hearing thresholds and air-bone gap decreased in 87 cases after the revisional operation, with statistically significant different in comparison to those two parameters before the operation (P<0.05).

CONCLUSIONThe primary causes responsible for the wet ear or reoccurrent cholesteatoma after tympanomastoid surgery may be related to the improper operation procedures and selection of incision, the non-standard operation, inexhaustive removal of pathological tissues, as well as the irregular postoperation change dressing, and other factors.

Adolescent ; Adult ; Child ; Cholesteatoma, Middle Ear ; surgery ; Chronic Disease ; Ear Auricle ; surgery ; Eustachian Tube ; pathology ; Female ; Humans ; Male ; Mastoid ; surgery ; Middle Aged ; Otitis Media ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; Reoperation ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; pathology ; surgery ; Tympanoplasty ; Young Adult