Objective To construct large medical model named by "Huaxi HongYi"and explore its application effectiveness in assisting medical record generation. Methods By the way of a full-chain medical large model construction paradigm of "data annotation - model training - scenario incubation", through strategies such as multimodal data fusion, domain adaptation training, and localization of hardware adaptation, "Huaxi HongYi" with 72 billion parameters was constructed. Combined with technologies such as speech recognition, knowledge graphs, and reinforcement learning, an application system for assisting in the generation of medical records was developed. Results Taking the assisted generation of discharge records as an example, in the pilot department, after using the application system, the average completion times of writing a medical records shortened (21 min vs. 5 min) with efficiency increased by 3.2 time, the accuracy rate of the model output reached 92.4%. Conclusion It is feasible for medical institutions to build independently controllable medical large models and incubate various applications based on these models, providing a reference pathway for artificial intelligence development in similar institutions.

Objective To investigate the predictive value of systemic immune-inflammation index (SII) for venous thrombo embolism (VTE) in patients with lung cancer.Methods The patients with lung cancer admitted and treated in Chengdu Municipal Second People's Hospital from March 2022 to October 2023 were selected as the study subjects and divided into the VTE group (n=33) and the non-VTE group (n=37) ac-cording to whether or not complicating VTE.The clinical characteristics and laboratory indexes were collect-ed.The multivariate logistic regress was used to analyze the influencing factors.The receiver operating charac-teristic (ROC) curve was drawn.The difference of the areas under curve (AUC) was compared.The Kaplan-Meier survival curve was used to evaluate the risk stratification capability of the related variables for VTE oc-currence in the patients with lung cancer.Results There were statistically significant differences in WBC,neutrophil,lymphocyte,albumin (ALB),D-dimer (D-D),plasma viscosity,neutrophil-to-lymphocyte ratio (NLR),platelet-to-lymphocyte ratio (PLR) and SII between the two groups (P<0.05).The multivariate lo-gistic regression analysis showed that high SII,tumor stage (Ⅲ-Ⅳ stage) and plasma viscosity were inde-pendent risk factors for VTE occurrence in the patients with lung cancer (P<0.05).The ROC curve analysis showed that AUC of the Khorana score,SII,modified Khorana score,NLR and PLR were 0.747,0.776,0.866,0.754 and 0.672,respectively.The predictive efficiency of SII for VTE occurrence in the patients with lung cancer was better than that of Khorana score,NLR and PLR.Conclusion High SII is an independent risk factor for VTE occurrence in the patients with lung cancer,its risk stratification for VTE occurrence in the pa-tients with lung cancer is conducive to early recognize the high risk population.

Objective: To explore the relationship between fruit intake and the risk of overweight with obesity in children, so as to provide references for the prevention of childhood obesity. Methods: From September to November 2014, a stratified cluster sampling method was used to select 6 369 children aged 6-12 from two elementary schools of a country in rural Chongqing for physical examinations and questionnaire surveys, and 1 814 children in grades 1-2 at baseline were followed up from March to May 2019. The relationship between fruit intake and the prevalence of overweight and obesity was analyzed. Results: According to the percentile of fruit intake, the 6 369 children at baseline were assigned to three groups: Q 1 (< P 33.3 , fruit intake <100 g/d), Q 2 ( P 33.3 - P 66.7 , fruit intake:100-214.3 g/d), and Q 3 (> P 66.7 , fruit intake >214.3 g/d). For the baseline survey results, children in the Q 2 group had a lower weight and Body Mass Index (BMI) ( P <0.05); the prevalence of overweight and obesity among children in the Q 1 group was the highest (32.03%), and the prevalence of overweight and obesity among boys in the Q 2 group was the lowest (31.94%) after gender stratification ( P <0.05). The follow up survey results showed no significant differences between the three groups in terms of changes in height, weight, and BMI ( P >0.05); but the prevalence of obesity among youth in the Q 2 group was the lowest (5.07%, P <0.05). Compared with youth in the Q 2 group, the risk of obesity was higher among those in the Q 1 group at baseline survey ( OR=1.41, 95%CI=1.10-1.81, P <0.05), and was higher among those in the Q 3 group at follow up survey ( RR= 1.83, 95%CI=1.21-2.75, P <0.05). Conclusion Deviating from moderate fruit intake may increase the likelihood of overweight and obesity in children, and it is recommended that children are encouraged to consume fruits as part of a well balanced diet to prevent the occurrence of obesity.

Objective:To analyze clinical manifestations, pathological features and prognosis of patients with stage Ⅰ cutaneous melanoma.Methods:Clinical data were collected from 163 patients with stage Ⅰ cutaneous melanoma in Department of Dermatology, Xijing Hospital from January 2010 to January 2020, and clinical manifestations, pathological features, treatment methods and prognosis were retrospectively analyzed.Results:Among the 163 patients with stage Ⅰ cutaneous melanoma, 56 (34.36%) were males, and 107 (65.64%) were females, with a median age of 53 years at the clinic visit. Primary skin lesions were most frequently located on the extremities in 104 cases (63.80%) , of which 39 presented with lesions on the finger or toe nails and 65 with lesions on the other parts of the extremities; skin lesions were located at sun-exposed sites such as the head and face in 29 (17.79%) cases, and at non-sun-exposed sites such as the trunk and extremities except the hands and feet in 30 (18.40%) . Of the 163 patients, 56 (34.36%) were pathologically diagnosed with stage ⅠA cutaneous melanoma, and 107 (65.64%) with stage ⅠB cutaneous melanoma. According to a pathological staging system, 104 (63.80%) patients suffered from acral lentiginous melanoma, 23 (14.11%) superficial spreading melanoma, 15 (9.20%) nodular melanoma, 14 (8.59%) malignant lentigo-maligna melanoma, and 7 (4.29%) other rare or difficult-to-determine types. All the 163 patients received surgical treatment at least once, of whom 15 underwent finger or toe amputation, 94 extended resections, and 54 unextended resections; 35 received secondary surgeries, of whom 33 underwent extended resections and 2 finger amputation. Seven patients developed postoperative lymph node and/or distant organ metastases, 2 of whom died after distant organ metastases. The 5-year survival rate of the 163 patients was 98.00%.Conclusion:Stage Ⅰ cutaneous melanoma commonly has favorable prognosis, and 7 patients developed postoperative lymph node and/or distant organ metastases in this study, suggesting that long-term follow-up of patients with acral melanoma and early intervention of those with metastatic melanoma should be strengthened.

Humans ; Pilot Projects ; Prospective Studies ; Pulmonary Emphysema/surgery* ; Lung/surgery* ; Emphysema ; Perfusion ; Tomography, Emission-Computed ; Tomography ; Tomography, Emission-Computed, Single-Photon ; Pneumonectomy ; Bronchoscopy/methods*

BACKGROUND: Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy; however, the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion. This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis, improve the first-pass success rate and patients' tolerance, and reduce postoperative bleeding. METHODS: This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: control group, simple cotton bud detection group (CD group), and adrenaline + lidocaine detection group (AD group). The primary outcome was the time to pass the glottis. Secondary outcomes included the first-pass success rate, the patients' tolerance scores, and post-operative bleeding. One-way analysis of variance, Kruskal-Wallis H test, Chi-squared test, Fisher's exact test, and Bonferroni's multiple comparison tests were used in this study. RESULTS: In total, 189 men and 111 women were enrolled in this study, with a mean age of 55.72 ± 12.86 years. The insertion time was significantly shorter in the AD group than in the control group (18.00 s [12.00-26.50 s] vs . 24.00 s [14.50-45.50 s], P = 0.005). Both the AD (99% vs . 83%, χ2 = 15.62, P < 0.001) and CD groups (94% vs . 83%, χ2 = 5.94, P = 0.015) had a significantly higher first-pass success rate than the control group. Compared with the control group, post-operative bleeding (1% vs . 13%, χ2 = 11.06, P < 0.001) was significantly lower in the AD group. However, no significant difference was found in the patients' tolerance scores. CONCLUSIONS: Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis, improve the first-pass success rate, and reduce post-operative nasal bleeding. Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000032668; http://www.chictr.org.cn/showprojen.aspx?proj=53321 .
Adult ; Aged ; Bronchoscopes ; Bronchoscopy/methods* ; Epinephrine/therapeutic use* ; Female ; Humans ; Lidocaine/therapeutic use* ; Male ; Middle Aged ; Postoperative Hemorrhage/prevention & control* ; Prospective Studies

Objective:To search, evaluate and summarize the best evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy, and to provide reference for clinical practice in order to reduce the complications during labor, such as the proportion of instrument delivery, prolonged labor duration, uterine rupture, postpartum hemorrhage, etc. Standardize the management process of induction of labor with oxytocin, improve the satisfaction of pregnant women to participate in the decision of induction of labor, and improve the outcome of the newborn.Methods:Take the evidence-based nursing method, in view of the full-term pregnancy pregnant women oxytocin drip induced labor evidence-based labor management problems, nearly 10 years related literature retrieval from January 1st 2011 to April 9th, 2021, the Australian JBI evidence-based health care center of literature quality evaluation criteria and evidence classification system, all kinds of research evaluation and classification of retrieval.Results:Early detection to 340 articles, and eventually into 9 articles, including 1 clinical decision, 6 guides, 2 pieces of system evaluation. Totally 45 pieces evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy were sumarized, including induced labor time, oxytocin side effects, induced labor before evaluation, induced labor of guardianship, infusion solution, such as health education, and other seven aspects.Conclusions:The present study summarized 45 pieces of best evidence on the management of labor induced by oxytocin infusion during term pregnancy, which provided some evidence-based basis for midwives, obstetric nurses and managers. Through the application of the best evidence, it is beneficial to improve the outcome of pregnant women in the neonatal perinatal period, standardize the process of inducing labor with oxytocin, and improve the quality of obstetric care.

Objective:To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019 (COVID-19) patients with hypertension.Methods:The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension.Results:Four patients, two males and two females, with an average age of 78 years (66-87 years), were referred to hospital mainly because of respiratory symptoms. Three were diagnosed by positive novel coronavirus 2019 (2019-nCoV) nucleic acid or antibody, and the critical patient with cardiac insufficiency was clinically determined. Two patients were treated with calcium channel antagonist (CCB), one with angiotensin converting enzyme inhibitor (ACEI), and one with angiotensin Ⅱ receptor antagonist (ARB). After admission, ACEI and ARB were discontinued, one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks. Based on comprehensive treatment including antiviral and oxygenation treatment, blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events. All patients were finally discharged.Conclusion:Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

Objective    To provide recommendations for the management of intensive care unit patients without novel coronavirus disease 2019 (COVID-19). Methods    We set up a focus group urgently and identified five key clinical issues through discussion. Total 23 databases or websites including PubMed, National Guideline Clearing-House, Chinese Center for Disease Control and Prevention and so on were searched from construction of the library until February 28, 2020. After group discussion and collecting information, we used GRADE system to classify the evidence and give recommendations. Then we apply the recommendations to manage pediatric intensive care unit in the department of  critical care medicine in our hospital. Results    We searched 13 321 articles and finally identified 21 liteteratures. We discussed twice, and five recommendations were proposed: (1) Patients should wear medical surgical masks; (2) Family members are not allowed to visit the ward and video visitation are used; (3) It doesn’t need to increase the frequency of environmental disinfection; (4) We should provide proper health education about the disease to non-medical staff (workers, cleaners); (5) Medical staff do not need wear protective clothing. We used these recommendations in intensive care unit management for 35 days and there was no novel coronavirus infection in patients, medical staff or non-medical staff. Conclusion    The use of evidence-based medicine for emergency recommendation is helpful for the scientific and efficient management of wards, and is also suitable for the management of general intensive care units in emergent public health events.

Objective To investigate the effect of predictive nursing intervention on prevention of pressure sore in liver transplantation.Methods Eighty patients undergoing liver transplantation were randomly divided into two groups.Patients in the control group were given traditional nursing care.Patients in the experimental group were treated with predictive nursing intervention.Anxiety, depression, compliance, quality of life, stress indicators, infection rate, pressure sore rate and nursing satisfaction were compared.Results Compared with the control group, the scores of SAS and SDS in the experimental group were significantly higher than those in the control group;the compliance score and the QOL score group were significantly higher, the MDA level was significantly lower, SOD level was higher and the rate of infection and pressure ulcer was significantly lower than that of the control group, there were significant differences between the two groups(P<0.01).Conclusion Predictive nursing intervention is effective in prevention of pressure sore in liver transplantation and it can improve the satisfaction and has reference significance.