Objective To investigate the influencing factors of low cardiac output syndrome(LCOS)after coronary artery bypass grafting(CABG)and construct a nomogram model to predict the risk of LCOS occurrence.Methods A total of 231 patients with coronary atherosclerotic heart disease who underwent CABG surgery in the Heart Center of Henan Provincial People's Hospital from October 2019 to May 2022 were selected for the study.The patients were randomly divided into a training set(n=162)and a validation set(n=69)at a ratio of 7∶3.The comparability between the parameters of the patients in the training and validation sets was assessed.Based on the occurrence of LCOS after CABG,patients in the training set were divided into LCOS group(n=33)and non-LCOS group(n=129).Univariate and multivariate logistic regression analysis were conducted on the sample parameters in the training set to identify independent risk factors for LCOS after CABG.A nomogram prediction model for the risk of LCOS after CABG was constructed,and its discrimination,calibration,and clinical applicability were evaluated by using the receiver operating characteristic curve,calibration curve,and decision curve analysis.Results The incidence of LCOS in patients of the training and validation sets was 20.37％(33/162)and 18.84％(13/69),respectively.There were no statistically significant differences in various parameters between the training and validation sets(P＞0.05).In the training set,there were statistically significant differences in the following parameters between the non-LCOS group and the LCOS group patients,including age,heart rate,blood urea nitrogen,serum creatinine,estimated glomerular filtration rate(eGFR),serum N-terminal pro B-type natriuretic peptide(NT-proBNP),serum troponin T,left ventricular ejection fraction(LVEF),mitral regurgitation area,history of myocardial infarction,proportion of NYHA class Ⅲ-Ⅳ,proportion of patients requiring cardiopulmonary bypass,surgical duration,intraoperative bleeding volume,and postoperative hemodynamic indicators such as central venous pressure,pulmonary arterial diastolic pressure and pulmonary artery pulse index(PAPI)(P＜0.05).Multivariate logistic regression analysis showed that preoperative LVEF decrease[odds ratio(OR)=0.891,95％confidence interval(CI):0.832-0.954,P=0.001)],preoperative eGFR decrease(OR=0.963,95％CI:0.934-0.994,P=0.018),preoperative NT-proBNP increase(OR=1.001,95％CI:1.000-1.001,P=0.006),increased operation time(OR=1.013,95％CI:1.003-1.022,P=0.008),and postoperative PAPI reduction(OR=0.094,95％CI:0.028-0.319,P=0.000)were independent risk factors for LCOS after CABG.A nomogram prediction model was built based on these indicators.In the training set,the nomogram prediction model had an area under the curve(AUC)of 0.931(95％CI:0.890-0.972)for predicting the LCOS occurrence,with a sensitivity of 82.20％and a specificity of 90.90％.In the validation set,the AUC for predicting the LCOS occurrence was 0.907(95％CI:0.813-1.000),with a sensitivity of 96.40％and a specificity of 84.60％.This indicated that the model had high discrimination.The calibration curve showed good consistency between the predicted probability and the actual probability of LCOS occurrence in both the training and validation sets(average absolute error:0.038 and 0.026,respectively).The Hosmer-Lemeshow goodness-of-fit test demonstrated that the model's prediction deviation for the LCOS occurrence was not statistically significant compared to the actual occurrence(x2=6.381,6.907,P＞0.05),indicating good calibration of the model.Conclusion Decreased LVEF and eGFR and elevated NT-proBNP preoperatively,prolonged surgical duration,and decreased PAPI postoperatively are independent risk factors for LCOS after CABG.The nomogram prediction model established based on these factors has high discrimination,calibration,and clinical applicability,and can effectively predict the occurrence of LCOS after CABG.

Objective: To examine independent food purchasing behavior and influence factors among primary and secondary school students, and to provide evidence for formulating and implementing corresponding intervention measures. Methods: Using a two stage stratified random cluster sampling principle, 976 primary and secondary school students in Haidian District of Beijing were selected to participate in a questionnaire survey from March to May 2021, and students independent food purchases and associated factors were considered. Results: The proportion of middle school students who often purchased food independently (22.79%) was higher than that of primary school students(16.77%)( χ 2=5.58， P <0.05). The proportion of middle school students and primary school students who sometimes purchased food independently was 66.32% and 60.33%, respectively( χ 2=3.78， P >0.05). The proportion of middle school students who never purchased food independently (10.88%) was lower than that of primary school students(22.90%)( χ 2=25.10， P <0.05). The proportion of middle school students and primary school students who often purchased food with their parents was 30.80% and 32.52%, respectively( χ 2=0.33， P >0.05). The factors that primary and secondary school students often considered when purchasing food included personal factors (e.g., physical and psychological factors), family factors, social factors, and the food itself. The top five factors that middle school students often considered when purchasing food were taste, hygiene, production date, student s mood, and advertisement. The top five factors that primary school students often considered when purchasing food were hygiene, taste, production date, advertising, and quality. The proportion of students with consideration of nutritional value, calorie level and collocation type, as well as other nutritional factors, when purchasing food was low, no significant differences were observed between primary and middle school students( χ 2=3.25，2.93，3.06， P >0.05). Conclusion Independent food purchasing behavior is prevalent among primary and secondary school students. Nutritional awareness among middle and primary school students is low. Effective and comprehensive nutrition interventions should be actively carried out for primary and secondary school students, while considering multiple dimensions such as schools, families and society, so as to encourage students to adopt a healthy diet.

Objective:To explore the willingness to engage in geriatric nursing services of students in geriatric related majors in universities of Xinjiang Uygur Autonomous Region, China (Xinjiang for short) , and analyze its influencing factors, so as to provide a reference for cultivating the geriatric nursing service personnel in Xinjiang.Methods:From September 2019 to July 2020, 976 students in geriatric related majors (the nursing major and geriatric service and management major) from 2 universities, a medical university and a vocational university in Xinjiang, were selected as the research object. Students were investigated with the Students' Willingness to Engage in Geriatric Nursing Services Questionnaire, and 50 students were interviewed with the structured interview.Results:Among 976 university students in geriatric related majors, 606 (62.09%) were willing to engage in geriatric nursing services. Logistic regression analysis showed that attitudes towards the aged, registered residence, experience of caring for the aged, living with the aged, attention to geriatric nursing information, and views on the prospects of geriatric nursing services were the influencing factors of students' willingness to engage in geriatric nursing services with a statistical difference ( P<0.05) . The results of grey relation analysis showed that the driving strength of the influencing factors of the willingness to engage in geriatric nursing services of students in geriatric related majors from strong to weak was views on the prospects of geriatric nursing services (the relation index was 0.944) and attitudes toward the aged (the relation index was 0.828) , experience of caring for the aged (the relation index was 0.763) , attention to geriatric nursing information (the relation index was 0.658) , living with the aged (the relation index was 0.600) and the registered residence (the relation index was 0.563) . Conclusions:The most critical influencing factor for students in geriatric related majors in Xinjiang universities to engage in geriatric nursing services is their views on the prospects of geriatric nursing services and their attitudes towards the aged. Universities should further strengthen the discipline construction and curriculum reforms of geriatric related majors, pay attention to the education of career prospects, cultivate a positive attitude towards the aged, and increase the willingness of students to engage in geriatric nursing services.

Objective:To explore the effect of empowerment health education on the biochemical indicators and self-efficacy of elderly diabetic patients, so as to provide a theoretical basis for choosing a health education model suitable for elderly diabetic patients.Methods:From January to July of 2020, convenience sampling was used to select 130 elderly diabetic patients who were treated in the Geriatric Outpatient Clinic of Beijing Friendship Hospital affiliated to Capital Medical University as the research object. All patients were divided into the intervention group and the control group according to the visit time, 65 cases in each group. The control group conducted regular health education, and the intervention group implemented empowerment health education. The blood glucose, blood lipid indexes and self-efficacy scores of the two groups of patients before and three months after the intervention were compared.Results:After intervention, the levels of glycosylated hemoglobin and triacylglycerol in the intervention group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . There was no significant difference in fasting blood glucose, two hours postprandial blood glucose, and low-density lipoprotein cholesterol levels between the two groups after intervention ( P>0.05) . The total scores of self-efficacy and the scores of strategic efficacy, and executive efficacy of the intervention group after the intervention were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Empowerment health education is more effective than conventional health education in improving the self-efficacy of elderly diabetic patients, especially in terms of strategic efficiency and executive efficiency, and has a certain effect of improving some clinical biochemical indicators of elderly diabetic patients.

Tumor radiotherapy is established on the basis of clinical oncology, radio-physics and radiobiology, and has become one of the three major therapeutic methods for malignant tumors. With the pace of socialist construction in China, the subject of radiotherapy in Shanxi province has developed from scratch and from small to large for more than 60 years. Remarkable achievements have been made in the establishment of departments, the updating of technical equipment, the increase of employees and clinical scientific research. This article reviews and summarizes the development history of tumor radiotherapy in Shanxi province.

Objective To evaluate the effect of hyperbaric oxygen (HBO) therapy on postoperative cognitive dysfunction (POCD) in elderly patients undergoing general anesthesia.Methods A total of 112 patients,aged 65-75 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective non-cardiac surgery with general anesthesia,were randomly divided into control group (C group,n =54) and HBO group (n =58).Patients were exposed to hyperbaric oxygen in a hyperbaric oxygen chamber once a day from day 3 to day 12 after surgery in both groups.Pressure was slowly increased to 2 atmosphere absolute within 20 min,pure oxygen was inhaled for 35 min by mask,5 min later pure oxygen was inhaled for another 35 min,oxygen inhalation was then stopped and pressure was slowly increased to 1 atmosphere absolute in HBO group.Patients inhaled air at 1 atmosphere absolute for 70 min in C group.Cognitive function score was assessed using Mini-Mental State Examination,language ability test,visual identification function test,digit span backwards task and Hasegawa's Dementia Scale (HDS) at 2 days before surgery and 7 and 13 days after surgery.The development of POCD was recorded.Results Compared with the baseline at 2 days before surgery,language ability test,digit span backwards task and HDS scores were significantly decreased at 7 and 13 days after surgery in C group,and digit span backwards task scores were significantly decreased at 7 days after surgery in HBO group (P＜0.05 or 0.01).The language ability test and HDS scores were significantly higher,and the incidence of POCD was lower at 7 and 13 days after surgery in HBO group than in C group (P＜0.05).Conclusion HBO therapy can reduce POCD in elderly patients undergoing general anesthesia.

Objective The incidence of gastrointestinal symptoms in diabetes is higher than that of non-diabetes.Thus,the aim of the present study was to observe the efficacy and safety of bifidobacterium tetragenous viable bacteria tablets in the treatment of constipation in patients with type 2 diabetes mellitus.Methods This is a multicenter,randomized,double-blind,placebo-controlled,parallel group-comparison clinical research.The subjects were randomly divided into study group and control group according to 1 ∶ 1 ratio by computer generated random number method.The subjects were either treated with bifidobacterium tetragenous viable bacteria tablets (study group) or placebo (control group) for eight weeks,and they were followed up for four weeks without changing foundation therapy for diabetes.The primary outcome was the change of complete spontaneous bowel movements (CSBMs).Results A total of 234 subjects (the study group:116 cases;the control group:118 cases) from 7 centers were included in the present study.The baseline characteristics were comparable between the two groups.In the study group,the CSBMs at 0,2,4,8 and 12 weeks were 0.0(0.0,1.0),1.0(0.5,2.0),2.0(1.0,3.0),3.0(2.0,3.5),2.0(1.0,3.0) times per week,respectively,while the CSBMs of the control group at each corresponding weeks were 0.0(0.0,1.0),1.0(0.0,1.5),1.0(0.0,1.5),1.0(0.0,2.0),1.0(0.0,1.5)times per week,respectively.There is significant difference in CSBMs between the two groups (P＜0.05).Moreover,after 12 weeks treatment,the CSBMs over spontaneous bowel movements (SBMs) ratio in the study group was higher than that in the control group [0.53 (0.40,0.67) vs 0.33 (0.00,0.50),P=0.048],indicating a more complete evacuation sensation in the study group.More subjects in the study group (66.38％) reached Bristol stool classification of normal criteria than those in the control group (48.31％,P=0.005).There were significantly improvement of bowel function index in the study group [study group 42.7 (33.3,56.7),control group 60.6 (51.7,75.7),P＜0.000 1].Furthermore,the symptoms of constipation was improved,and the satisfaction for the treatment was high in the study group.There were no significant differences of the safety indicators between the two groups.Conclusions Bifidobacterium tetragenous viable bacteria tablets can be used in patients with type 2 diabetes mellitus and constipation.Compared with placebo,it improves constipation and has no obvious adverse effects.

Objective To explore the effects of surgery treatment on the diagnostic delay of Crohn's dis-ease(CD)in early stage. Methods The effects of surgical operation on diagnostic delay of early stage CD were an-alyzed,and the risk factors that in high surgical rate on early diagnosis were evaluated by comparing the surgical cases with non-surgical cases before the diagnosis of CD.Results The ratio of male and female in the total 215 pa-tients with CD was 1.7 to 1.There were 114 cases with complications including 75 cases with surgery before diagno-sis,39 cases with non-surgical complications and 101 cases with no complications.The age of onset and age of di-agnosis in the three groups were significantly different(P < 0.05),and there was no significant difference in the time of diagnosis(P > 0.05). The most common complications were perianal lesion(p,abscesses and/or fistula) (49.1%),intestinal obstruction(23.7%),and the diseases of appendix(12.3%).The most common causes of pre-operative diagnosis were perianal lesion(38.7%),the lesion of appendix(17.3%),intestinal obstruction(16.0%) and the abdominal surgery(10.5%)whereas intestinal perforation is most easily recognized by histopathology. The rate of male surgery was high whereas the incidence of female complications was low. All three groups of lesions were found to be in ileocolon(L3)in which the operation group with pure small intestine was significantly higher than that in the group with no complications and in the group with non-surgical complications(P<0.05).Also the proportion of diseases behaving stricturing(B2)+penetrating(B3)was 60%,but the complication group behaving inflammatory(B1)+B2 was 87.2%,the group with no complications behaving B1 reached 68.3%.and The compli-cation group behaving P was 61.5% which was higher than the operation group(44.0%).There was a significant dif-ference between the three groups(P<0.001).Conclusions Diagnostic delay of CD on the early was significantly associated with surgery operation. Male,age 17~40,lesion site L3 or intestinal-type,disease behaving B2 and B3,were the high risk factors for preoperative surgery;while women,aged 17-40,with or without chronic compli-cations,were more likely to obtain early diagnosis,less surgical risk,and relatively good prognosis.Perianal lesion were early characteristic expressions of CD and could be used as an regularization indicator for screening.The sec-ond was the recurrent intestinal obstruction.most of the stomach resection and the repeated diarrhea after gallblad-der should be awared of CD.

Objective To explore the efficacy and safety of bifidobacterium tetragenous viable bacteria tablets (BTVBT) in blood glucose control in patients with type 2 diabetes mellitus (T2DM).Methods This study was a randomized, double-blind, placebo parallel comparison, multicentre clinical research.The subjects were T2DM patients who were using anti-hyperglycemic drugs.They were randomly divided into observation group and control group according to 1∶1 ratio.The subjects accepted the therapy of BTVBT or placebo by oral administration (3 tablets, tid) for eight weeks, followed up for 4 weeks, during which the basic treatment maintained unchanged.The primary outcomes: the changes of glycosylate hemoglobin A1c (HbA1c) from baseline.Results Totally 234 subjects (116 cases in observation group and 118 cases in control group) from 7 centers were included in the study.The baseline characteristics were comparable between these two groups.The HbA1c was (8.00±1.08)％ and (7.99±1.03)％ in observation group and control group, respectively, at baseline, and was (7.28±1.28)％ and (7.36±1.02)％ after 12 weeks of treatment [(-0.66±1.38)％ vs.(-0.64±1.14)％,P=0.914 5].The secondary outcomes were as follows: the fasting blood glucose (FBG) in the observation group were (7.91±1.87)mmol/L and (8.05±2.33)mmol/L at baseline and after 12 weeks of treatment;while in the control group, the FBG were (8.51±1.68)mmol/L and (8.00±2.02)mmol/L, and comparisons between two groups showed no significant change (P>0.05).The glycated albumin in the observation group and control group were (21.38±5.74)％ and (21.93±6.51)％ at baseline;after 4 weeks of treatment, they were (20.08±6.05)％ and (20.58±7.30)％ (the changes from baseline in these two groups were (-1.19±4.37)％ and (-1.20±5.08)％];after 8 weeks of treatment, they were (19.07±5.56)％ and (20.83±8.74)％ [the changes from baseline were (-2.09±4.51)％ and (-0.98±6.85)％];after 12 weeks of treatment, they were (19.03±5.19)％ and (19.36±6.14)％ [the changes from baseline were (-2.18±4.60)％ and (-2.47±5.20)％], there were no significant differences between two groups (P>0.05).The subgroup analysis showed that in those patients with the characteristics including body mass index (BMI)≥25 kg/m2 at baseline, the duration of diabetes mellitus longer than 8 years, fasting blood glucose less than 8 mmol/L and using insulin at baseline, the changes of HbA1c from baseline to the end of 12 weeks therapy in the observation group were more than in the control group.There were no significant differences between the two groups in terms of safety profiles, including the vital signs and laboratory findings (blood cell counts, liver function, and kidney function, all P>0.05).Conclusion Administration of BTVBT in T2DM patients for 12 weeks does not remarkably improve the HbA1c.

Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children′s hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.