Postoperative acute kidney injury in major noncardiac surgery. Narrative review / Lesión renal aguda posoperatoria en cirugía mayor no cardiaca. Revisión narrativa

Abstract Postoperative acute kidney injury is an underdiagnosed condition. Its incidence is variable and depends on demographic, clinical, and surgical stress-associated factors; hence the pathophysiology is multifactorial. It is extremely important to acknowledge those risk factors early and use tools to estimate the risk of developing the condition, in order to adopt perioperative measures to mitigate its occurrence and impact. Some of the complications resulting from this condition include prolonged ICU stay, higher susceptibility for infections, hospitalization-related complications, progression to acute and chronic kidney failure, and even the need for transient or permanent renal replacement therapies (RRT) in addition to diseases that increase the cardiovascular risk, such as systemic high blood pressure and/or coronary heart disease that result in increased comorbidities and mortality, with subsequent increases in healthcare costs, lower quality of life and increased burden of the disease in the short and long term. A systematic search of the literature was conducted in PubMed, Google Schoolar, and Lilacs, under the terms MeSh and DeCs using Boolean operators; a review was conducted of the summary of the articles identified and 57 of them were selected for their comprehensive reading. This narrative review summarizes the relevant information on this pathology for prevention and identification purposes, for the adequate management of patients undergoing major non-cardiac surgery.

Resumen La lesión renal aguda posoperatoria es una entidad subdiagnosticada. Su incidencia es variable y depende de factores demográficos, clínicos y los inherentes al estrés quirúrgico; por ende, la fisiopatología es multifactorial. Es de vital importancia reconocer precozmente dichos factores de riesgo durante la valoración preanestésica y hacer uso de herramientas para calcular el riesgo de desarrollarla para, de esta forma, adoptar medidas perioperatorias para mitigar su aparición e impacto. Entre las complicaciones derivadas de esta entidad se encuentran la estancia en unidades de cuidado intensivo prolongadas, mayor susceptibilidad de infecciones, complicaciones derivadas de la hospitalización, progresión a enfermedad renal aguda y crónica e incluso necesidad de terapias de reemplazo renal (TRR) transitorias o permanentes, además de enfermedades que aumentan el riesgo cardiovascular como hipertensión arterial sistémica y/o enfermedad coronaria, lo que genera aumento en morbimortalidad, con aumento en costos asociado a la atención en salud, menor calidad de vida y mayor carga de la enfermedad a corto y largo plazo. Se realizó una búsqueda sistemática de la literatura en bases de datos PubMed, Google Schoolar, Lilacs, bajo los términos MeSh y DeCs, usando los operadores booleanos, se revisó el resumen de los artículos encontrados y se seleccionaron 57 artículos para su lectura completa. Esta revisión narrativa sintetiza la información relevante sobre esta patología que permita prevenirla y reconocerla para el manejo adecuado de los pacientes que van a cirugía mayor no cardiaca.

Experiencia en reconstrucción del paciente gran quemado agudo con microcirugía

Introducción: Las quemaduras son un trauma frecuente de ocurrencia en todo el mundo, que ha experimentado importantes aumentos de sobrevida. Su manejo requiere la reposición de la barrera cutánea, lo que se logra en la mayoría de los casos con el uso de injertos dermo-epidérmicos. Sin embargo, existen algunas veces lesiones complejas que no logran sanar mediante injertos, arriesgando la funcionalidad o vitalidad del área comprometida, que requerirán reparaciones complejas con el uso de colgajos microqui- rúrgicos (CM). Metodología: Estudio descriptivo retrospectivo en que incluimos todos los pacientes gran quemados agudos admitidos en Hospital de Urgencia de la Asistencia Pública, Servicio de Quemados y Rehabilitación, desde abril de 2019 hasta diciembre de 2020 los que fueron manejados con colgajo micro- quirúrgico. Revisión de ficha clínica para obtención de variables demográficas y del procedimiento con análisis de frecuencia de ocurrencia. Resultados: En nuestro período de estudio hubo 376 ingresos y 21 pacientes recibieron 25 CM. La mayoría hombres (96%), edad promedio 40 años, superficie comprometida promedio 16%, mecanismo más frecuente electricidad (64%) y fuego (32%). La ubicación más frecuente del colgajo fue en extremidades inferiores (64%) y el colgajo más utilizado fue el anterolateral de muslo (80%). Tiempo medio a reconstrucción fueron 40 días, no hubo pérdida total del colgajo. Discusión: se realizó un CM en 5,6% de nuestros ingresos, la mayoría durante el intervalo primario tardío, sin pérdidas totales. Estos resultados representan la consolidación de la técnica que permite su uso en el paciente gran quemado durante su etapa aguda, permitiendo coberturas complejas y manteniendo riesgo quirúrgico y tasa de complicaciones adecuada con enfoque en rehabilitación precoz.

Introduction: Burns are the fourth most common trauma. Microsurgery has evolved as a valuable tool in the acute setting allowing early closure of complex wounds in order to avoid infection, maintain function or even for limb salvage in one stage reconstruction. We present our experience at our burn center in Chile. Method: We performed a retrospective analysis of all major burn patients admitted in the National Burn Center in Chile who received a microsurgical flap in the period between April 2019 to December 2020. Results: A total of 21 patients had 25 free flaps. All patients but one were male (96%), mean age 40 years (range 20-69 years). Total body surface area means 16% (range 1-64%). Most of the injuries were caused by high voltage electricity (64%) and fire (32%). 64% were performed in lower limbs and 36% in upper limbs. In 80% of the cases, anterolateral thing flap was chosen. Mean time to reconstruction was 40 days. We didn't experience a total flap lost in this series. Discussion: In the acute phase microsurgery proved to be safe and feasible albeit a small surgical indication. We performed a flap in 5.6% of our admissions, mostly during late primary interval with no flaps lost. Our results acknowledge the consolidation of the technique for its use in the acutely burned setting, allowing complex coverage while maintaining the surgical risk and an internationally acceptable rate of losses and complications.

Correlation of anthropometric measurements with pretransfusion haemoglobin in transfusion dependent thalassemia major children

Background: The etio-pathogenesis of growth failure in transfusion dependent thalassemia major (TDTM) children is mainly because of chronic anemia, iron overload and endocrine complications. Aim was to determine the association between anthropometric measurements with pre-transfusion haemoglobin in TDTM children.Methods: Present cross-sectional study included total 55 children between 5-18 years of age who were diagnosed as TDTM. Mean pre transfusion hemoglobin of last 1 year was obtained from previous medical records. Anthropometric measurements like weight in kg and height in cm measured while body mass index (BMI) was calculated using standard formula in each patient. Weight for age, height for age, and BMI were plotted on WHO 2006 and Indian academy of paediatrics 2015 combined growth charts in terms of percentile. Data was analysed statistically.Results: Total 55 children of TDTM between 5-18 years of age were studied. The mean age was 10.42(4.07) years. The mean weight (kg), height (cm) and BMI was 23.76 (7.5), 123.94 (18.13) and 15.24 (1.76) respectively. Fifty-one (92.73%) children were having BMI less than 3rd centile (Underweight). Forty (93.02%) and 11 (91.66%) children between age group of 5-10 years and more than 10 years were underweight and was statistically significant (p<0.05). Total 50 (94.33%) children were having mean pre transfusion hemoglobin below 9 gm/dl who were underweight which was statistically significant.Conclusions: Low pre-transfusion hemoglobin is one of the risk factors for growth failure in children with TDTM and it should be maintained above 9 gm/dl may for normal growth in children with TDTM.

The Maneuver of Psychobiotics in the Medical Aid of Clinical Depression

The field of psychology has advanced over the years in treating psychiatric disorders such as major depressive disorder (MDD), Schizophrenia, and Alzheimer's disease (AD). Depression or clinical depression is a major mental health issue characterized by chronic sadness, hopelessness, and emptiness, which diminishes the patient's quality of life. According to WHO, an estimated 3.8% of the world's population experience depression, in which 15% of depressed patients eventually die by suicide. Recent studies in treating depressive patients have progressed with the usage of psychobiotics. Psychobiotics contain both probiotics and prebiotics, meaning psychobiotics possess the ability to introduce beneficial bacteria in the gut as well as support the growth of existing bacteria in the human gut. The gut-brain axis, which mediates the mechanism of action of psychobiotics in treating clinical depression, has been cleverly studied, and it provides promising results in the improvement of a patient's mental health status. Psychobiotics have proven their worth not only in upgrading the patient's mental health in psychological disorders but also in the enhancement of overall patient health by improving one's gut health.

Evaluation of Demirjian stage of the third molar as a reliable predictor of 18 years age

Background: In accordance with section 3(1) of the 1875 Indian majority act, any individual residing in India must reach the majority age when they reach the age of 18 and not before. Third molar formation begins approximately the age of 18. This study aims to distinguish the third molar Demirjian stage(s) indicate that the individual is under the age of 18, and which do not, we will be able to determine the person's age. Methods: In this research, 202 patients' OPG radiographs aged 14-25 years were obtained. Their radiographs revealed 742 third molars in total. Third molar development was examined using Demirjian's eight-stage method, and average age was then calculated for each step of third molar growth. Stages under the age of eighteen and stages over the age of eighteen were analyzed. Results: Data revealed that a person was in stage C most likely under the age of 18 (minor) and at stage H, a person was most likely over the age of 18 (major). Stages A and B were not evident in the age range studied. The age associated with stage C was less than 18 years, while the age associated with stage H was greater than 18 years. Conclusions: Assessing third molar growth stages is a reliable non-invasive method for estimating an individual's age. Stage H indicates a likely age over 18 with completed root development, while stage C suggests an age under 18 with ongoing root development, making it a quick and useful approach.

Factores predictivos negativos para hemorragia mayor en posoperados de cambio valvular aórtico por minitoracotomía / Negative predictors of major bleeding in postoperative aortic valve replacement via mini-thoracotomy

Resumen Introducción: La estenosis aórtica es la valvulopatía más común y requiere tratamiento quirúrgico. Las técnicas quirúrgicas mínimamente invasivas han surgido como alternativas a la esternotomía media tradicional. Objetivo: Analizar los posibles factores de riesgo asociados a la hemorragia mayor a lo habitual en pacientes sometidos a cambio valvular aórtico por minitoracotomía anterior derecha, y compartir los resultados encontrados en nuestro centro. Materiales y método: Se llevó a cabo un estudio observacional, longitudinal y retrospectivo con pacientes operados por minitoracotomía anterior derecha entre julio de 2015 a diciembre de 2022. Se recopilaron datos demográficos y clínicos, así como información sobre las variables generales y quirúrgicas relevantes. Resultados: Se observó una edad media de 58 años en los pacientes estudiados, con una mayor presencia de hombres menores de 65 años. De los pacientes estudiados, solo 3 (4.47%) presentaron hemorragia mayor a lo habitual. Se encontró una asociación entre la edad avanzada y el tiempo de circulación extracorpórea (minutos) con hemorragia mayor a lo habitual. Conclusiones: Los resultados del estudio indican que la incidencia de hemorragia mayor a lo habitual fue baja en la cirugía mínimamente invasiva realizada. La edad avanzada y el tiempo prolongado de circulación extracorpórea se identificaron como factores de riesgo significativos para hemorragia mayor a lo habitual. Sin embargo, se destaca la necesidad de realizar estudios con una muestra más amplia para comprender mejor estos factores y la seguridad de la cirugía mínimamente invasiva.

Abstract Introduction: Aortic stenosis is the most common valvular heart disease requiring surgical treatment. Minimally invasive surgical techniques have emerged as alternatives to traditional median sternotomy. Objective: To analyze the possible risk factors associated with major bleeding in patients undergoing aortic valve replacement via right anterior mini-thoracotomy and to share the results found in our center. Materials and methods: A retrospective, observational, longitudinal study was conducted in patients undergoing right anterior mini-thoracotomy from July 2015 to December 2022. Demographic and clinical data, as well as relevant surgical and echocardiographic variables, were collected. Results: The mean age of the study population had a mean age of 58 years, with a predominance of men under 65 years of age. Only three patients experienced major bleeding 4.47%. Advanced age and extracorporeal circulation time (minutes) were associated with bleeding. No significant differences were found in other variables analyzed. Conclusions: The study results indicate a low rate of postoperative bleeding in minimally invasive surgery. Advanced age and prolonged extracorporeal circulation time were identified as significant risk factors for major bleeding. However, further studies with a larger sample size are needed to better understand these factors and the safety of minimally invasive surgery.

Uso de la tomografía corporal total en pacientes con heridas de arma de fuego y hemodinámicamente inestables: ¿Rompiendo paradigmas de atención inicial? / Whole-body computed tomography in hemodynamically unstable patients with gunshot wounds: A paradigm shift in trauma management?

Introducción. El objetivo del estudio fue analizar el impacto del uso de la tomografía corporal total en la evaluación de los pacientes con trauma penetrante por proyectil de arma de fuego y hemodinámicamente inestables atendidos en un centro de referencia de trauma. Métodos. Se realizó un estudio analítico, retrospectivo, con base en un subanálisis del registro de la Sociedad Panamericana de Trauma ­ Fundación Valle del Lili. Se incluyeron los pacientes con trauma penetrante por proyectil de arma de fuego atendidos entre 2018 y 2021. Se excluyeron los pacientes con trauma craneoencefálico severo, trauma leve y en condición in extremis. Resultados. Doscientos pacientes cumplieron los criterios de elegibilidad, 115 fueron estudiados con tomografía corporal total y se compararon con 85 controles. La mortalidad intrahospitalaria en el grupo de tomografía fue de 4/115 (3,5 %) vs 10/85 (12 %) en el grupo control. En el análisis multivariado se identificó que la tomografía no tenía asociación significativa con la mortalidad (aOR=0,46; IC95% 0,10-1,94). El grupo de tomografía tuvo una reducción relativa del 39 % en la frecuencia de cirugías mayores, con un efecto asociado en la disminución de la necesidad de cirugía (aOR=0,47; IC95% 0,22-0,98). Conclusiones. La tomografía corporal total fue empleada en el abordaje inicial de los pacientes con trauma penetrante por proyectil de arma de fuego y hemodinámicamente inestables. Su uso no se asoció con una mayor mortalidad, pero sí con una menor frecuencia de cirugías mayores.

Introduction. This study aims to assess the impact of whole-body computed tomography (WBCT) in the evaluation of patients with penetrating gunshot wounds (GSW) who are hemodynamically unstable and treated at a trauma referral center. Methods. An analytical, retrospective study was conducted based on a subanalysis of the Panamerican Trauma Society-FVL registry. Patients with GSW treated between 2018 and 2021 were included. Patients with severe cranioencephalic trauma, minor trauma, and those in extremis were excluded. Patients with and without WBCT were compared. The primary outcome was in-hospital mortality, and the secondary outcome was the frequency of major surgeries (thoracotomy, sternotomy, cervicotomy, and/or laparotomy) during initial care. Results. Two hundred eligible patients were included, with 115 undergoing WBCT and compared to 85 controls. In-hospital mortality in the WBCT group was 4/115 (3.5%) compared to 10/85 (12%) in the control group. Multivariate analysis showed that WBCT was not significantly associated to mortality (aOR: 0.46; 95% CI 0.10-1.94). The WBCT group had a relative reduction of 39% in the frequency of major surgeries, with an associated effect on reducing the need for surgery (aOR: 0.47; 95% CI 0.22-0.98). Conclusions. Whole-body computed tomography was employed in the initial management of patients with penetrating firearm projectile injuries and hemodynamic instability. The use of WBCT was not associated with mortality but rather with a reduction in the frequency of major surgery.

Diagnosis and treatment status quo of major aortopulmonary collateral arteries in congenital heart disease with decreased pulmonary blood flow / 国际儿科学杂志

The congenital heart disease with decreased pulmonary blood flow is one type of congenital heart disease characterized by reduced pulmonary blood flow. Common clinical types include tetralogy of Fallot，pulmonary atresia，double outlet right ventricle，and other complex malformations associated with pulmonary artery stenosis. Due to the lack of pulmonary blood supply from the right ventricle，children with this condition often have major aortopulmonary collateral arteries（MAPCAs）or the ductus arteriosus participating in pulmonary circulation for blood supply. Research has revealed that MAPCAs are important factors which cause the increase of mechanical ventilation time，intensive care unit stay time，complication rate and mortality after radical surgical treatment of congenital heart disease with decreased pulmonary blood flow. Therefore，the treatment of MAPCAs in perioperative period is crucial. This article summarizes the research progress of MAPCAs distribution and influence，diagnosis and evaluation，and treatment methods，to provide the reference for clinicians to standardize MAPCAs treatment.

The predictive value of t-PA,CgA,LP-PLA2 for MACE after percutaneous coronary intervention / 国际检验医学杂志

Objective To investigate the predictive value of tissue plasminogen activator(t-PA),chro-mogranin A(CgA),and lipoprotein related phospholipase A2(LP-PLA2)in serum for major adverse cardio-vascular event(MACE)after percutaneous coronary intervention(PCI).Methods A total of 120 patients with coronary heart disease who underwent PCI in the hospital from August 2020 to August 2022 were en-rolled in the study.According to whether MACE occurred within 1 year after PCI,the patients were divided into MACE group(33 cases)and non-MACE group(87 cases).The levels of serum t-PA,CgA,LP-PLA2 and clinical data were compared between the MACE group and the non-MACE group.Multivariate Logistic regres-sion was used to analyze the risk factors of MACE after PCI.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of t-PA,CgA and LP-PLA2 alone or in combination for MACE after PCI.Results The proportion of patients with smoking history,NT-proBNP,CgA,LP-PLA2,and the propor-tion of patients with hypertension in the MACE group were higher than those in the non-MACE group(P＜0.05),while left ventricular ejection fraction(LVEF)and t-PA were lower than those in the non-MACE group(P＜0.05).There were no significant differences in age,gender composition,serum creatinine,triglyc-erides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),drinking history,NYHA cardiac function classification,combined diabetes,application of aspirin,and application of clopidogrel between the two groups(P＞0.05).Multivariate Logistic regression analysis showed that smoking history,increased NT-proBNP,hypertension,decreased LVEF,decreased t-PA,increased CgA and increased LP-PLA2 were risk factors for MACE after PCI(P＜0.05).ROC curve analysis showed that the areas under the curves(AUCs)of serum t-PA,CgA and LP-PLA2 alone or in combination for predicting MACE after PCI were 0.785(95％CI:0.693-0.877),0.678(95％CI:0.564-0.791),0.730(95％CI:0.636-0.824),0.888(95％CI:0.830-0.946),respectively.The efficacy of combined prediction was bet-ter than those of single detections(P＜0.05).Conclusion The lower the serum t-PA level is and the higher the CgA and LP-PLA2 levels are,the greater the risk of MACE after PCI is.The combination of the three in-dicators has higher value in predicting MACE after PCI.

Key technology selection for research and development of vaccines for response to emerging pandemic diseases / 军事医学

Vaccination is the most cost-effective means of prevention and control of infectious diseases,and is a prioritized strategy for responding to pandemic diseases.Based on experience related to research and development of vaccines for coronavirus disease 2019(COVID-19),we used literature research and expert consultation methods to screen thirty key technologies in nine sub-fields of vaccine technology,which were ranked according to the importance,urgency,innovation and feasibility so as to show where every key technology stood in relation to others in the pineline.The priorities of development of key technologies for vaccines in response to major emerging infectious diseases were recommended to provide reference for related decision-makers in their effort to rationalize research resources and maximize the benefits.

The major adverse kidney events in acute myocardial infarction with extracorporeal cardiopulmonary resuscitation / 中华急诊医学杂志

Objective:To investigate the major adverse kidney events (MAKE) in acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, with/without renal replacement therapy (RRT), and whether to initiate RRT because of acute kidney injury (AKI). age, sex, Charlson comorbidity index, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO and RRT treatment time, 90-day survival rate were analyzed. Moreover, the renal function of the survivors was followed up.Results:① Total of 68 AMI-ECPR patients were enrolled, 22 (32.4%) patients survived at 90 days, 54 (79.4%) combined with RRT, and 48 (70.6%) MAKE within 90 days. ②Compared with the death group, the 90-day survival group had a higher proportion of initial shockable heart rhythm, a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value. ③The severity of coronary artery disease, ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group, and all the non-RRT group patients survived. ④ There was no difference between the AKI-RRT group and the non-AKI-RRT group. Of 21 patients with stage 1 AKI initiating RRT, 5 survived, one of them still needs RRT for 90 days, and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions:The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6%, and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0%. Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.

Predictive model for extubation delay undergoing non-emergency major surgery based on random forest algorithm / 临床麻醉学杂志

Objective To construct and validate a clinical prediction model for delayed extubation undergoing non-emergency major surgery based on the random forest algorithm.Methods Clinical data of 7 528 patients undergoing non-emergency major surgery under general anesthesia from January 2018 to De-cember 2022 were retrospectively collected.The patients were divided into two groups according to whether extubation was performed within 2 hours after surgery:non-delayed extubation group(≤2 hours)and de-layed extubation group(＞2 hours).All the patients were randomly divided into a training set and a valida-tion set in a ratio of 7 ∶ 3.The predictive factors for delayed extubation after surgery were screened through LASSO regression and Logistic regression.The random forest model was established and verified by random forest algorithm.Results There were 123 patients(1.6%)experienced delayed extubation after surgery.ASA physical status,department,intraoperative use of flurbiprofen ester,dexmedetomidine,glucocorticoid,hypocalcemia,severe anemia,intraoperative blood transfusion,and airway spasm were identified as inde-pendent predictive factors for delayed extubation.The area under curve(AUC)value of the random forest prediction model in the validation set was0.751(95%CI0.742-0.778),and the sensitivity was98.1%,and the specificity was 41.9%.Conclusion The predictive model of delayed extubation undergoing non-e-mergency major surgery based on random forest algorithm has a good predictive value,which may be helpful to prevent delayed extubation undergoing non-emergency major surgery.

Thoughts on the Formulation of"2023 Guidelines for Diagnosis and Treatment of Depression with Integrative Chinese and Western Medicine" / 世界科学技术-中医药现代化

The integration of Chinese and Western Medicine(ICWM)in the diagnosis and treatment of depression has been a long-standing issue in the field of mental health.In order to maximize the benefits of this combined approach,the"2023 Guidelines for Diagnosis and Treatment of Depression with Integrative Chinese and Western Medicine"(GDTD-ICWM)has been developed based on organizing evidence-based and standardized workflows for ICWM.This article aims to discuss the background,highlights,summary and outlook of the"Guidelines",as well as offer operational suggestions to guide clinical practices in order to strengthen the implementation,practice and promotion of the"Guidelines".

Efficacy and Safety of Acupuncture in Treating Major Depressive Disorders:A Systematic Review and Meta Analysis / 世界科学技术-中医药现代化

Objective To evaluate the effectiveness and safety of acupuncture in patients with Major Depressive Disorders.Methods Search the database for relevant literature published before April 15,2023.Select randomized controlled trial that meeting the enrollment criteria,evaluate the quality of the literature and classify before meta-analysis systematic evaluation.Results 15 RCTs are included in this study,with a total of 1077 patients.The results showed that acupuncture treatment,compared with antidepressants alone,The score of Hamilton Depression Scale(HAMD)in patients with liver-qi depression disorder[MD=-0.73,95%CI(-1.22,-0.24),P<0.05],the score of TCM Syndrome Scale[MD=-1.89,95%CI(-2.35,-1.44),P<0.001],effective rate[RR=1.09,95%CI(1.03,1.153),P=0.001]and TESS score[MD=-2.76,95%CI(-3.68,-1.85),P<0.001]were statistically significant.Compared with fluoxetine hydrochloride,the effective rate of HAMD scale score was statistically significant[RR=1.07,95%CI(1.01,1.14),P<0.05].Conclusion Compared with antidepressants alone,acupuncture therapy has the advantages for the improvement of HAMD score in patients,the improvement of Traditional Chinese medicine symptoms,and significantly less adverse effects than those in the control group.Through this study,it is considered that acupuncture can be a safe and effective treatment modality.However,due to the quantity and quality of the included literature,the above conclusions still need to be verified by more high-quality clinical trials.

Clinical characteristics and prognosis of patients with myocardial infarction with non-obstructive coronary arteries / 沈阳医学院学报

Objective:To investigate the clinical characteristics of patients with myocardial infarction with non-obstructive coronary arteries(MINOCA)and the risk factors of major adverse cardiovascular events(MACE)within 1 year of follow-up.Methods:A total of 1 866 patients who met the diagnosis of acute myocardial infarction and underwent coronary angiography in the Department of Cardiovascular Medicine of our hospital from Sep 2018 to Sep 2021 were selected.According to the results of coronary angiography,the patients were divided into MINOCA group and myocardial infarction with obstructive coronary artery disease(MI-CAD)group.The clinical characteristics and the occurrence of MACE in the two groups were compared.According to the occurrence of MACE,patients in MINOCA group were divided into MACE group and non-MACE group.Binary logistic regression analysis was used to explore the risk factors for MACE in MINOCA patients.Results:The age of patients in MINOCA group was lower than that in MI-CAD group,and more patients were female(P＜0.05).The risk factors of cardiovascular diseases in MINOCA group were less than those in MI-CAD group(P＜0.05).Some indexes of laboratory were lower than those in MI-CAD group(P＜0.05).Left ventricular ejection fraction(LVEF)were higher than that in MI-CAD group(P＜0.05).Left ventricular end-diastolic inner diameter(LVEDD)was lower than that in MI-CAD group,and the proportion of patients with abnormal ventricular wall motion and high cardiac function grade was lower than that in MI-CAD group,and the difference was statistically significant(P＜0.05).The 1-year follow-up showed no significant difference in the incidence of MACE between the two groups(P=0.115).Binary logistic regression analysis showed that smoking(OR=13.095,95%CI:1.799-7.398)and low LVEF(OR=0.036,95%CI:0.012-0.679)were independent risk factors for MACE in MIONCA patients.Conclusions:MINOCA patients are more common in women,with lower age and fewer cardiovascular risk factors,but the incidence of MACE is not less than that of MI-CAD patients.Smoking and low LVEF are independent risk factors for MACE in MINOCA patients.

Effect of stage Ⅰ comprehensive cardiac rehabilitation in patients with acute ST elevation myocardial infarctionafter emergency percutaneous coronary intervention / 实用医学杂志

Objective This study aimed to investigate the effect of stage Ⅰ comprehensive cardiac rehabili-tation in patients with acute ST elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods A total of 72 patients with acute ST-segment elevation myocardial infarction combined with PCI admitted to the Department of Cardiovascular Medicine of Beijing Electric Power Hospital of State Grid Corporation from June 2021 to June 2022,which were selected as the research objectsand divided into control group and observation group randomly(36 cases in each group).The control group was treated with routine nursing and health education,and the observation group with stage Ⅰ comprehensive cardiac rehabilitation,including initial assessment(cardiovascular comprehensive assessment),exercise training(exercise training and breathing train-ing),daily activity suggestions and health education,discharge assessment(six-minute walking test and Barthel index assessment).The score of Barthel index(BI)at discharge,the 6-minute walking test distance(6MWD)at discharge,the incidence of major adverse cardiovascular event(MACE)during hospitalization and within one month of discharge,and the length of stay were compared between the two groups.Results After intervention,the six-minute walking test distance(6MWD)and Barthel index(BI)score in the observation group were better than those in the control group,the difference was statistically significant(P<0.05).The incidence of major adverse cardiovascular events(MACE)during hospitalization and one month after discharge was lower in the observation group than in the control group,and the difference was statistically significant(P<0.05).The length of hospital-ization in observation group was lower than that in control groupbut there was no statistical difference(P>0.05).Conclusion The application of phase Ⅰ comprehensive cardiac rehabilitation training in patients with acute ST-segment elevation myocardial infarction combined with emergency PCI could improve the patients'exercise ability,improve their ability of daily activity,reduce the incidence of major adverse cardiovascular events(MACE)in the early stage of the disease,facilitate the patients to return to their families and society as soon as possible,and improve their quality of life.It has high clinical application value.

Application of the integrated medical and industrial training model in the training of oncology talents from the perspective of new medical sciences / 中国综合临床

The medical-industrial fusion training model combines the knowledge and technology of medical and engineering disciplines in the training of oncology graduate students, which can help accurate diagnosis and treatment of tumors, promote cooperation and innovation in oncology research, as well as promote the cultivation and exchanges of composite and innovative medical talents in oncology, promote the innovation and development of oncology diagnostic and treatment technology, and improve the survival rate and quality of life of oncology patients. This paper discusses the application of medical-industrial fusion training model in the training of o ncology professionals, and explores the new teaching mode of medical-industrial fusion thinking in the cultivation of complex and innovative medical talents in oncology under the background of "new medical science".

Construction and evaluation of a nomogram for adverse cardiovascular events within 1 year after PCI in elderly patients with ACS / 中华老年心脑血管病杂志

Objective To construct a nomogram prediction model for major adverse cardiovascular events(MACE)within 1 year after percutaneous coronary intervention(PCI)in elderly patients with acute coronary syndrome(ACS).Methods A retrospective analysis was conducted on 551 patients with diagnosed ACS and undergoing PCI in Department of Cardiovascular Medicine of Air Force Medical Center from 1 January 2020 to 1 April 2022.According to the occurrence of MACE during 1 year of follow-up,they were classified into MACE group(n=176)and non-MACE group(n=375).Risk factors for the occurrence of MACE in elderly ACS patients within 1 year after PCI were analysed using univariate and multivariate logistic regression,a nomogram prediction model was constructed,and the predictive power of the model was assessed using the area under the ROC curve(AUC).Results The MACE group had significantly higher Gensini score,systemic immune-inflammation index,and GRACE score,but obviously lower prognostic nutritional index than the non-MACE group(P＜0.01).Multivariate logistic regression analysis showed that recent smoking(OR=2.222,95％CI:1.361-3.628,P=0.010),hyperlipidaemia(OR=1.881,95％CI:1.145-3.089,P=0.013),prognostic nutritional index(OR=4.645,95％CI:2.788-7.739,P=0.001),LVEF(OR=5.177,95％CI:3.160-8.483,P=0.001),systemic immune-inflammation index(OR=5.396,95％CI:3.179-9.159,P=0.001),and preoperative di-agnosis of non-STEMI(OR=2.829,95％CI:1.356-5.901,P=0.006)or STEMI(OR=3.451,95％CI:1.596-7.463,P=0.002)were independent influencing factors for occurrence of MACE after PCI in elderly ACS patients.ROC curve analysis showed that the AUC value of the nomo-gram model for predicting MACE within 1 year after PCI in elderly ACS patients was 0.888.Con-clusion Our developed nomogram model is simple and practical,and can effectively predict the occurrence of MACE within 1 year after PCI in elderly ACS patients.And external validation should be carried out to ensure its generality.

Efficacy and safety of enhanced external counterpulsation in elderly patients with acute ischemic stroke complicated by coronary heart disease / 中华老年心脑血管病杂志

Objective To explore the efficacy and safety of enhanced external counterpulsation(EECP)in elderly patients with acute ischemic stroke(AIS)complicated by coronary heart dis-ease(CHD).Methods A total of 65 AIS patients with CHD admitted in our hospital from Janu-ary to June 2023 were recruited and randomly divided into a control group(drug secondary pre-vention,n=32)and a treatment group(drug combined with EECP therapy,n=33).Their NIHSS score,mRS score and Canadian Cardiovascular Society(CCS)angina grade were evaluated before and after treatment and compared between the two groups.The incidences of recurrent ischemic stroke,new hemorrhagic stroke and major adverse cardiovascular events(MACE)were also recor-ded during treatment.Results The NIHSS score and mRS score were significantly decreased in both groups after treatment(P＜0.01).After treatment,the NIHSS score(2.67±1.63 vs 3.56± 1.83),mRS score[1.0(0.0,1.0)vs 2.0(1.0,2.0)]and CCS grade[1.0(1.0,2.0)vs 2.0(1.0,2.0)]were obviously lower in the treatment group than the control group(P＜0.05,P＜0.01).There were no statistical differences in the incidence rates of recurrent ischemic stroke,new-onset hem-orrhagic stroke,and MACE between the control group and the treatment group(9.4％vs 6.1％,6.3％vs 3.0％,12.5％vs 6.1％,P＞0.0 5).Conclusion EECP is a safe and effective treatment option for elderly AIS patients with CHD.

Efficacy and safety profile of repetitive transcranial magnetic stimulation versus modified electroconvulsive therapy in combination with antidepressants in patients with major depressive disorder / 四川精神卫生

BackgroundMajor depressive disorder is one of the most disabling mental diseases. Currently， medication in combination with physiotherapy and psychotherapy remains the most commonly used treatment modality for the disease， whereas only a few randomized controlled studies have been conducted on physiotherapy， and even fewer studies have focused on medication combined with physiotherapy. ObjectiveTo explore the efficacy and safety profile of repetitive transcranial magnetic stimulation （rTMS） versus modified electroconvulsive therapy （MECT） in combination with antidepressants in the treatment of major depressive disorder， so as to provide an optimized treatment plan for patients with major depressive disorder. MethodsPatients with major depressive disorder （n=335） hospitalized in Shandong Daizhuang Hospital from January 1， 2019 to April 30， 2023 were included， all of whom met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10）. Depending on their disease condition， patients were subjected to either MECT in combination with drugs （n=141） or rTMS in combination with drugs （n=194） after admission. Depressive symptoms were assessed using Hamilton Depression Scale-24 item （HAMD-24） at the baseline and the end of the 1st， 2nd， 3rd and 4th week of treatment， and the adverse reactions were documented in patient's medical records. ResultsAnalysis of variance on HAMD-24 revealed a significant effect of time （F=3.081， P=0.042）， but no effect of group （F=1.023， P=0.313）， and the interaction effect between the time and the groups was not statistically significant （F=1.642， P=0.191）. No statistical difference was reported between two groups in response rate and full remission rate （P>0.05）. Throughout the course of treatment， 58 cases （41.13%） of recent memory impairment and 74 cases （52.48%） of headache or neck muscle pain occurred in MECT combined with drugs group， and 27 cases （13.92%） in rTMS combined with drugs group experienced headache or head skin discomfort. ConclusionAntidepressants in combination with rTMS or MECT show equivalent efficacy in the treatment of major depressive disorder， while rTMS combined with antidepressants demonstrates a superior safety profile compared to MECT.