Aim To study the causal relationship between coffee consumption and atherosclerosis risk.Methods Based on the public genome database IEU Open GW AS project website,relevant data were obtained,and in-strumental variables closely related to exposure and outcome were screened.Mendelian randomization analysis was per-formed using the inverse variance weighted method,weighted median method,and MR Egger method to assess the causal relationship between coffee consumption and arteriosclerosis(including coronary atherosclerosis,peripheral atherosclerosis,cerebral atherosclerosis,and other atherosclerosis).In addition,the Egger intercept method was used to detect the level of pleiotropy,the Cochran Q test was used to assess the heterogeneity,and the leave one out method was used to perform sensitivity analysis,so as to ensure the robustness of the results.Results The study showed that the F-values of the instrumental variables included in the study were all greater than 10,and there was no weak instrumental variables bias.Coffee consumption was positively correlated with the risk of coronary atherosclerosis(OR=1.535 5,95％CI=1.108 4～2.127 2,P=0.009 9),peripheral atherosclerosis(OR=2.098 6,95％CI=1.182 2～3.725 7,P=0.011 4),and other atherosclerosis(OR=1.864 7,95％CI=1.052 9～3.302 4,P=0.032 6),but not with the risk of cerebral atherosclerosis.Heterogeneity test Q_pval＞0.05,level pleiotropy test interval P＞0.05.Conclusions The single nucleotide polymor-phisms selected in the study are all strong instrumental variables,and there is no heterogeneity or horizontal pleiotropy,in-dicating reliable results.The research shows that coffee consumption increases the risk of coronary atherosclerosis,pe-ripheral atherosclerosis and other atherosclerosis,and has no significant correlation with the risk of cerebral atherosclerosis.The health management of atherosclerosis patients should reduce coffee consumption.

Objective To summarize the best evidence on nonpharmacological prevention of postpartum depression and to provide the evidence-based basis for clinic and community to implementing non-pharmaco-logical prevention of postpartum depression.Methods The evidences such as related clinical decision making,guidelines,expert consensus,systematic reviews,etc.on non-pharmacologic prevention and management of postpartum depression were systematically retrieved from computer decision system,the guidelines websites,Chinese and English databases and related society websites.The retrieval time was from the database establis-ment to April,2023.Results A total of 23 papers were included,among them,there were 2 clinical decisions,3 guidelines,1 expert consensus and 15 systematic evaluations,2 evidence summaries.Six aspects of non-phar-macological prevention of postpartum depression were summarized,including building multidisciplinary teams,screening and evaluation,psychological intervention,social support,exercise intervention,and self-care,and 23 pieces of evidence were extracted.Conclusion This study summarizes the best evidence for the preven-tion of postpartum depression,suggesting early identification of high-risk groups and the medical staff should provide personalized and comprehensive prevention and intervention programs for postpartum depression ac-cording to the risk factors existing in parturient,so as to reduce the incidence of postpartum depression and re-duce the burden of society and families.

Objective:To compare and analyze the clinical diagnostic values of five thyroid nodule malignant risk stratification guidelines.Methods:From October 2019 to October 2021, 926 cases of patients with 1 027 thyroid nodules were recruited in the Second Affiliated Hospital of Xi ′an Jiaotong University. All nodules were categorized individually according to 2015 American Thyroid Association for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults Guidelines(ATA guidelines), 2016 the Korean Society of Radiology and the Korean Society of Thyroid Radiology Thyroid Imaging Reporting and Data Systems(K-TIRADS), 2017 European Thyroid Association Thyroid Imaging Reporting and Data Systems(Eu-TIRADS), 2017 American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR TI-RADS), and 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS). The pathological results were taken as the gold standard, the malignancy ratio of nodules of different categories in each system was calculated. ROC curves were plotted to evaluate the diagnostic efficiencies of different systems, and DeLong test was used to compare the areas under ROC curves. The sensitivity and specificity of different systems were calculated when the maximum point of the Youden index was the optimal cut-off value.Results:In the same stratified system, there were statistically significant differences in the malignant proportion of nodules of different grades ( P<0.05). The malignant proportion of nodules in the high-risk group showed no significant difference among different stratified systems ( P>0.05). Except for C-TIRADS, the malignant proportion of nodules was increased with the increase of diagnostic grade at each grade of the other four stratification systems. ROC curve showed that AUCs of ATA guidelines, K-TIRADS, EU-TIRADS, ACR TI-RADS and C-TIRADS were 0.814, 0.819, 0.814, 0.820 and 0.802, respectively, there was no statistical significance in AUC of different stratification systems (all P>0.05). The optimal truncation values in differentiating benign and malignant nodules were middle-risk malignant nodules, moderately suspicious malignant nodules, middle-risk malignant nodules, class 4 and class 4B. The diagnostic of five stratification systems showed that ATA guidelines had the highest sensitivity (0.784), C-TIRADS had the highest specificity (0.854). Conclusions:The five stratified systems have similar efficacy in differentiating benign and malignant thyroid nodules, and all of them have good diagnostic value.

OBJECTIVE: To investigate the correlation between sonographic, hysteroscopic, and pathological findings in postmenopausal asymptomatic patients with sonographically thickened endometrium. METHODS: The records of postmenopausal patients who attended the Menopause Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey between January 1, 2012 and December 15, 2013 were retrieved. A total of 266 postmenopausal women without vaginal bleeding underwent hysteroscopic evaluation and endometrial sampling. Patients whose pathological records indicated an endometrial thickness equal to or greater than 6 mm (double layer) on transvaginal ultrasonography without any symptoms were included in the study. RESULTS: The most frequently detected focal intrauterine lesions in asymptomatic women were endometrial polyps, which were diagnosed in 168 (63.1%) cases. Twenty-four (9%) patients were diagnosed as having simple hyperplasia, 4 (1%) atypical hyperplasia, and 8 (3%) endometrial adenocarcinoma. Two of the patients with adenocarcinoma were diagnosed based on endometrial polyps, and 6 cases showed endometrial hyperplasia on hysteroscopy, while histological examination showed endometrial carcinoma. CONCLUSION: We suggest 10.5 mm as the cutoff value for endometrial thickness and recommend hysteroscopy following dilatation and curettage to increase diagnostic efficacy and provide definitive treatment in asymptomatic postmenopausal women with thickened endometrium.
Adenocarcinoma ; Ambulatory Care Facilities ; Dilatation and Curettage ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Hyperplasia ; Hysteroscopy ; Menopause ; Polyps ; Postmenopause ; Turkey ; Ultrasonography ; Uterine Hemorrhage

Objective: To evaluate the application effect of the platform switching implants in maxillary anterior region, to explore the effect of platform switching technology on the surrounding tissues. Methods: 55 patients with 60 single maxillary anterior implants were divided into two groups: platform-switching implants group (Ankylos), 25 patients with 28 implants; butt-joint implants group (Nobel Replace), 30 patients with 32 implants. The patients received follow-up care more than 1 and 2 year after the final setting of the prosthesis, at which time periapical radiographs were taken. The marginal bone level around the implant and Pink Esthetic Score (PES) were measured for comparison. Results : The average marginal bone changes of platform-switching implants after 1 year and 2 year were (-0.41 ± 0.36) mm and (-0.55 ± 0.33) mm respectively; and the ones of butt-joint implants were (-1.77 ± 0.54) mm and (-1.82 ± 0.61) mm. The average PES of platform- switched implants after 1 year and 2 year were 10.43 ± 1.37 and 10.32 ± 1.21 respectively; the ones of butt-joint implants were 9.21 ± 0.97 and 9.16 ± 0.95. There were significantly differences of marginal bone changes and PES between both groups (P < 0.05). Conclusion Platform switching implant in the maxillary aesthetics area is more effective in preserving the surrounding bone tissue and aesthetic effect.

Introduction: This report describes a case of hyperactive delirium induced by tapenatadol whose symptoms were successfully managed with opioid-switching to oxycodon. Case: A 67-year-old female, who had been treated with chemotherapy for malignant thymoma, had to stop chemotherapy because of her carcinomatous pericarditis. Tapentadol 200 mg per day was administrated for her unbearable chest wall tumor invasion-related somatic pain. After a while, insomnia, visual hallucination, thought disturbance, and attention disturbance were appeared. We diagnosed as hyperactive delirium. Because her somatic pain was favorably controlled by tapentadol, we additionally administered quetiapine 50 mg per day instead of replacing tapentadol. Unfortunately, quetiapine was not effective for the delirium. We therefore switched opioids from tapentadol to oxycodon. The delirium was remitted soon after the switching without relapsing of the pain. Conclusion: Tapentadaol reportedly induce hyperactive delirium via its noradrenaline reuptake inhibitory action. This case suggests that switching tapenatadol to other opioid could be an effective option for opioid induced delirium.

Objective To compare effect of trichosanthin and methotrexate in the treatment of uterine scar pregnancy by a multi-center study. Methods 90 uterine scar pregnancy patients were selected from department of obstetrics and gynecology,in xinyang central hospital,the second affiliated hospital of zhengzhou university,zhumadian central hospital,using random number table divided into 2 groups.The control group of 45 cases were treated by methotrexate,gluteal muscle injection,50 mg one time,and took mifepristone 50 mg,two times a day,a week for a course of treatment;45 cases in the experimental group,were treated with trichosanthin,intramuscular injection of 1.2 mg/time,two times a day,and oral administration of bloven,0.6 g/d,a week for a course of treatment.The end of a course of treatment,2 groups of patients before and after treatment were compared of the serum progesterone level,β-HCG,side reactions after treatment.Results After treatment,progesterone levels were significantly reduced,and the experimental group levels were lower than the control group obviously,the difference has statistical significance(P<0.05).Serum -HCG level after the treatment significantly reduced,and the experimental group in serum -HCG levels were significantly lower,with statistical difference (P <0.05 ). Comparison of adverse reaction of the patients,the experimental group was obviously lower than control group,with statistically significant difference (P<0.05).Conclusion For the treatment of uterine scar pregnancy,trichosanthin and methotrexate have certain effect,but trichosanthin could lower serum progesterone,β-HCG levels more significantly than methotrexate,trichosanthin group side reaction rate is low.

ObjectiveTo explore the applied methods and the effect of double-cavity balloon urinary catheter in the treatment of epistaxis.MethodsClinical data of 96 epistaxis patients who were operated with postnasal packing applied double-cavity balloon urinary catheter at our unit were analyzed retrospectively.ResultsAll patients ( 100％ ) were successfully healed.One patient suffered from anterior nostril stenosis because of the constriction by urinary catheter.The rest was no significant complications.ConclusionPostnasal packingl applied double-cavity balloon urinary catheter had a safe and effective method for treatment of severe epistaxis.Attention to detail in the operation could prevent the occurrence of complications.

OBJECTIVE: To explore the clinical effectiveness of endoscopic myringoplasty with homoplastic amniotic membrane. METHOD: A retrospective study in 43 patients underwent endoscopic myringoplasty with homoplastic amniotic membrane was observed at the wound healing of tympanic membrane perforation and the hearing improve-threshold audiometry in 43 patients after surgery. RESULT: The tympanic membrane's perforation healing rate was 95.3% (41/43), and air conduction threshold audiometry in language frequency improved average 10 dB. The follow up was 1--4 years, and no recurrence or complications had occurred. CONCLUSION The endoscopic myringoplasty could be able to simple myringoplasty whose air conduction threshold audiometry in language frequency was less than 40 dB. It could be used to repair not only the central perforation in tympanic membrane, but also the marginal perforation which has residual tympanic membrane in most of the regional. Human amniotic membrane is an ideal materials for repair of tympanic membrane.
Adolescent ; Adult ; Amnion ; transplantation ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Myringoplasty ; methods ; Otitis Media, Suppurative ; surgery ; Retrospective Studies ; Transplantation, Homologous ; Treatment Outcome ; Tympanic Membrane Perforation ; surgery ; Young Adult

Objective To explore the effect of whole course integrated health education on depressive emotion and self-concept modification in depressive patients and to improve their psychological rehabilitation. Methods Sixties depressive inpatients treated with antidepressive drugs were randomly assigned to receive supportive psychological nursing and general health education (control group 28) or whole course integrated health education (experimental group 32). Hamilton Depression Scale ( HAMD), Tennessee Self-Concept Scale (TSCS) and Symptom Checklist 90(SCL-90) were used before and after intervention to evaluate the clinical effects of two groups. Results Before interventions,the total scores of HAMD,TSCS and SCL-90 were (24.8 ±4. 3) ,(249.68 ±16.23) and(136.39±34.26)in experimental group and (24. 9 ±4. 2) , (248. 74 ± 17. 32) and( 136. 52 ± 35.04) in control group, with no significant difference between two groups (all P ＜ 0.01). After intervention, the total scores of HAMD, TSCS and SCL-90 were (19.7±2.8),(263.55±19.53) and (114.22 ± 18. 75) in experimental group and (22.4 ± 3. 3), (253. 66 ± 18. 37) and (134. 56 ± 32. 64) in control group, with significant difference between two groups (all P＜0.01). Conclusions Whole course integrated health education can improve depressive emotion of patients with depression, develop their positive self-concept and boost their mental health level.