Objective To construct a nomogram model for predicting delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in emergency departments. Methods All patients with acute carbon monoxide poisoning who visited the Department of Emergency of Zigong Fourth People’s Hospital between June 1st, 2011 and May 31st, 2023 were retrospectively enrolled and randomly divided into a training set and a testing set in a 6∶4 ratio. LASSO regression was used to screen variables in the training set to establish a nomogram model for predicting DEACMP. The discrimination, calibration, and clinical practicality were compared between the nomogram and Glasgow Coma Scale (GCS) in the training and testing sets. Results A total of 475 patients with acute carbon monoxide poisoning were included, of whom 41 patients had DEACMP. Age, GCS and aspartate aminotransferase were selected as risk factors through LASSO regression, and a nomogram model was constructed based on these factors. The areas under the receiver operating characteristic curves for nomogram and GCS to predict DEACMP in the training set were 0.897 [95% confidence interval (CI) (0.829, 0.966)] and 0.877 [95%CI (0.797, 0.957)], respectively; and those for nomogram and GCS to predict DEACMP in the testing set were 0.925 [95%CI (0.865, 0.985)] and 0.858 [95%CI (0.752, 0.965)], respectively. Compared with GCS, the performance of nomogram in the training set (net reclassification index=0.495, P=0.014; integrated discrimination improvement=0.070, P=0.011) and testing set (net reclassification index=0.721, P=0.004; integrated discrimination improvement=0.138, P=0.009) were both positively improved. The calibration of nomogram in the training set and testing set was higher than that of GCS. The decision curves in the training set and testing set showed that the nomogram had better clinical net benefits than GCS. Conclusion The age, GCS and aspartate aminotransferase are risk factors for DEACMP, and the nomogram model established based on these factors has better discrimination, calibration, and clinical practicality compared to GCS.
ObjectiveTo investigate the impact of deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion (ACP) on cognitive function of patients undergoing surgical therapy for acute Stanford type A aortic dissection (AD). MethodsBetween January 2009 and March 2012, 48 patients with acute Stanford type A AD underwent Sun's procedure (aortic arch replacement combined with stented elephant trunk implantation) under DHCA with ACP in Nanjing Hospital affiliated to Nanjing Medical University. There were 40 males and 8 females with their age of 51.3±13.6 years. Circulatory arrest time and time for postoperative consciousness recovery were recorded. Preoperative and postoperative cognitive functions of each patient were evaluated by mini-mental status examination (MMSE). ResultsMean cardiopulmonary bypass time of the 48 patients was 237.3±58.5 minutes, and mean circulatory arrest time was 37.3 ±6.9 minutes. Four patients died postoperatively with the causes of death including lung infection, multiple organ dysfunction syndrome, myocardial infarction and acute respiratory distress syndrome. Forty-one patients recovered their consciousness within 24 hours postoperatively, and the mean time for postoperative consciousness recovery was 15.3±6.5 hours. Preoperative MMSE score was 28.6±1.1 points, and MMSE score at 1 week postoperatively was 23.6±4.5 points. Thirty-one patients were followed up for 6 months with the follow-up rate of 70.45%. The average MMSE score of the 31 patients at 6 months after surgery was 27.6±2.1 points which was significantly higher than postoperative average MMSE score (P < 0.05), but not statistically different from preoperative average MMSE score (P > 0.05). ConclusionsDHCA with ACP can provide satisfactory cerebral protection for patients undergoing surgical therapy for acute Stanford type A AD, but patients' cognitive function may be adversely affected in the short term. As long as cerebral infarction or hemorrhage is excluded in CT scan of the brain, such adverse impact may generally disappear automatically within 6 months after surgery.
ObjectivTo investigate the incidence of depression and its etiological factors in patients with hypospadias after operation. MethodsFrom January to June 2015, we investigated the incidence of depression symptoms among patients with hypospadias after surgical treatment from January 1990 to December 1994 in Zhangzhou Affiliated Hospital of Fujian Medical University, and we matched them with mentally healthy adults of the same age to 1:1 ratio. Zung Self-Rating Depression Scale and Correlation Factor Questionnaire were used to investigate and analyze the related factors of depression symptoms between the patients with hypospadias and the healthy males. ResultsA total of 80 patients with hypospadias after surgical treatment and 80 healthy males as control were included. There were no significant differences in male secondary sexual development, testis development, serum testosterone levels and postoperative length and girth of the penis in two groups. The incidence rate of depression symptoms was 45.0% (16/80) in the hypospadias patients after operation, extremely significantly higher than 6.3% (5/80) in the control group (χ2=6.632, P=0.01). The result of multiple stepwise regression analysis showed that the main risk factors of depression symptoms were worries about dissatisfaction with penile and scrotal appearance (F=16.210 3, P=0.001), sexual satisfaction (F=4.621 2, P=0.036) and sexual function (F=4.103 2, P=0.043). ConclusionSymptoms of depression often occur in hypospadias patients after operation, and the major etiological factors are dissatisfaction with penile and scrotal appearance, sexual satisfaction and sexual function.
In order to accurately evaluate the similarity of motions during daily rehabilitation training for stroke patients, this paper proposed a novel quantitative assessment method based on dynamic time warping (DTW) algorithm. Firstly, the raw accelerometer signals were preprocessed to eliminate the noise. Secondly, the similarity between the accelerometer signals and four standard task templates was calculated respectively, and then the motion was recognized based on the similarity measurements. Finally, the corresponding quantitative assessment model was used to compute the result. The clinical experimental results showed that there were significant differences in the shortest path distance (R value) of DTW between different tasks, and the classification accuracy could be up to 91% when the R value was selected as the classification feature. Additionally, with the process of rehabilitation, the R value decreased gradually, which means that the R value can be taken as the assessment index to evaluate the quality of designated tasks for stroke patients. It also indicated that the R value could be applied into the scene of automatic prescription generation and interactive gaming to determine whether it is needed to change the rehabilitation plan or adjust the game difficulty level, so as to implement the individualized rehabilitation services.
ObjectiveThis study aimed to systematically review the quality of psychometric properties and methodological quality of the Chinese versions of fear of falling assessment tools for the elderly, providing evidence-based guidance for medical staff in selecting high-quality assessment tools. MethodsWe systematically searched CNKI, WanFang Data, VIP, CBM, PubMed, Embase, and Web of Science databases for studies related to the evaluation of psychometric properties and methodological quality of fear of falling assessment tools for the elderly. The search spanned from the inception of the databases to January 19, 2024. Two researchers independently screened literature and extracted data using the consensus-based standards for the selection of health measurement instruments. The COSMIN risk of bias checklist and quality criteria were employed to evaluate instrument measurement characteristics and formulate final recommendations. ResultsFifteen studies involving 11 Chinese versions of fear of falling assessment tools for the elderly were included. None of the studies reported measurement error, cross-cultural validity, or responsiveness. Due to insufficient or uncertain content validity and low or below-quality evidence, all 11 tools received a recommendation of level B. ConclusionAmong the 11 instruments, the Chinese version of IFES demonstrates the most balanced measurement characteristics, along with good reliability and validity. However, further verification of other measurement characteristics of this instrument is warranted.
ObjectiveTo explore the effects of drug management skill training on lightening the family burden of schizophrenic patients in their recovery period. MethodsBetween December 2011 and December 2013, 101 patients with schizophrenia were randomly divided into experimental group (n=56) and control group (n=45). The experimental group was given drug management skill training, while the control group only received routine follow-up. The course of the research was six months. Both groups were assessed by the positive and negative syndrome scale on patients' psychological symptoms, and family burden scale of diseases was used to assess the burden of the family. ResultsCompared with the controls, patients in the experimental group improved more in their positive symptoms (t=2.692, P=0.008), negative symptoms (t=2.729, P=0.008), general psychopathology symptoms (t=3.231, P=0.002) and the whole psychiatric symptoms (t=3.870, P<0.001). Moreover, the degree of patients' symptom improvement was positively correlated with the degree of family burden lightening (r=0.44, P<0.001). ConclusionFor patients with schizophrenia, reasonable drug management skill training can effectively improve patients' medication compliance, promote treatment effect and lighten family burden.
目的：對中藥配合肝動脈栓塞化療（Transcatheter Arterial Chemoembolization,TACE）輔助治療原發性肝癌隨機對照試驗(Randomized controlled trial,RCT)文獻進行評價。方法：對國內外公開發表的有關中藥配合TACE輔助治療原發性肝癌的隨機對照試驗進行檢索，檢索數據庫包括Cochrane圖書館臨床對照試驗庫，MEDLINE、CBM、CNKI和VIP電子數據庫。手工檢索中文相關期刊以及附加檢索相關會議論文集。質量評價采用Jadad評分量表、CONSORT標準和其他自擬評價指標進行分析。結果：共納入103篇RCTs，其中Jadad評分得5分有1篇文獻，3分1篇，2分10篇，71篇1分，其余20篇均為0分，有3篇文獻報告了分配隱藏。按CONSORT標準，僅1篇(0.97%)RCT描述了如何產生隨機順序，沒有RCT報道如何執行隨機，其中1篇為半隨機，有1篇(0.97%)RCT采用安慰劑對照，有54篇(52.43%)報道了終點指標，分別各有2篇(1.94%)報道了雙盲和單盲，14篇(1359%)進行了具體統計量計算，54篇(52.43%)提供了隨訪記錄，7篇(6.80%)報道了陰性結果，16篇(15.53%)報道不良事件，僅有1篇(0.97%)進行樣本含量計算與意向性分析(ITT),有2篇(1.94%)進行分層分析，屬于多中心的僅有1篇(0.97%)，均未進行倫理審批和知情同意。描述了中醫證型的有3篇(2.91%)。結論:目前中藥配合TACE輔助治療原發性肝癌臨床研究的方法學和報告質量尚低，且多數RCT可能存在選擇性偏倚和測量性偏倚，期待更多高質量的隨機雙盲對照試驗為臨床應用提供可靠的依據。
Objective To evaluate the reliability and validity of the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in preoperative anxiety in patients with local anesthesia. Methods From May to December 2020, a convenient sampling method was used to conduct an APAIS questionnaire survey on patients undergoing percutaneous renal biopsy in the Department of Nephrology, West China Hospital, Sichuan University, and the reliability and validity of the scale were analyzed. ResultsA total of 460 questionnaires were distributed and 444 valid questionnaires were returned, with a valid response rate of 96.5%. The Cronbach α of APAIS was 0.896, the Guttman split-half reliability was 0.811, and the content validity index was 0.891. The model fit was 12.122 for the chi-square fit index/degree of freedom, 0.916 for the goodness-of-fit index, 0.902 for the value-added fit index, 0.079 for the root mean square error of approximation, and 0.946 for the comparative fit index. The APAIS anxiety subscale score was positively correlated with the 7-item Generalized Anxiety Disorder Scale score (r=0.518, P<0.001). Conclusion The APAIS has good reliability and validity for evaluating the level of preoperative anxiety in patients with local anesthesia, but the application of the scale in other conditions requires further testing.
ObjectiveThis study aimed to revise the perioperative recovery scale for integrative medicine (PRSIM) based on item response theory (IRT). MethodsUnder the guidance of IRT, a total of 349 patient data collected during the development of the original version of PRSIM at Guangdong Provincial Hospital of Chinese Medicine were used. Principal component analysis was performed using SPSS 18.0 software to test the unidimensionality. The R language was utilized for parameter estimation, including discrimination coefficient, difficulty parameters and information content, as well as drawing item characteristic curves to assess item quality and estimate item functioning differences. A comprehensive screening process was carried out by combining expert consultations, patient evaluations, and discussions within a core group. ResultsThe degree of discrimination of all items ranged from ?0.535 to 2.195. The difficulty coefficient ranged from ?10.343 to 5.461, and the average information content of all items ranged from 0.043 to 1.075. Based on the criteria for parameter selection, nine items were retained. The results of expert consultations indicated the removal of 5 items and the modification of 7 items. After discussion within the core group, a final decision was made to remove 5 items. ConclusionBased on a synthesis of IRT and expert consultation feedback, and following discussions within the core group, a revised version comprising 15 items is retained and modified from the original 20 items.