Technology and Health Care最新文献

Background: Due to the high-risk nature of sepsis, emergency departments urgently need a simple evaluation method to assess the degree of inflammation and prognosis in sepsis patients, providing a reference for diagnosis and treatment.

Objective: To investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) combined with the blood urea nitrogen-to-serum albumin ratio (BAR) in sepsis.

Methods: A total of 377 sepsis patients admitted to Lishui People's Hospital from June 2022 to June 2023 were selected as the study subjects. Based on their prognosis, they were divided into a survival group (255 cases) and a death group (82 cases). The clinical data of the two groups were compared. Multivariate logistic analysis was used to identify factors influencing sepsis prognosis, and ROC curve analysis was used to assess the predictive efficacy of NLR, BAR, and their combination.

Results: Compared with survivors, non-survivors had higher NLR and BAR, with statistically significant differences (p< 0.05). After adjusting for confounding factors, NLR (OR = 1.052) and BAR (OR = 1.095) were found to be independent prognostic factors for sepsis patients (both p< 0.05). The AUC of NLR combined with BAR was 0.798 (95% CI 0.745-0.850, p< 0.05), higher than the AUC of NLR alone (0.776) and BAR alone (0.701).

Conclusions: The combination of NLR and BAR has a high predictive value for the prognosis of sepsis patients. Its simple calculation makes it particularly suitable for use in emergency departments.

Background: Artificial intelligence (AI) acts as the state-of-the-art in periodontitis diagnosis in dentistry. Current diagnostic challenges include errors due to a lack of experienced dentists, limited time for radiograph analysis, and mandatory reporting, impacting care quality, cost, and efficiency.

Objective: This review aims to evaluate the current and future trends in AI for diagnosing periodontitis.

Methods: A thorough literature review was conducted following PRISMA guidelines. We searched databases including PubMed, Scopus, Wiley Online Library, and ScienceDirect for studies published between January 2018 and December 2023. Keywords used in the search included "artificial intelligence," "panoramic radiograph," "periodontitis," "periodontal disease," and "diagnosis."

Results: The review included 12 studies from an initial 211 records. These studies used advanced models, particularly convolutional neural networks (CNNs), demonstrating accuracy rates for periodontal bone loss detection ranging from 0.76 to 0.98. Methodologies included deep learning hybrid methods, automated identification systems, and machine learning classifiers, enhancing diagnostic precision and efficiency.

Conclusions: Integrating AI innovations in periodontitis diagnosis enhances diagnostic accuracy and efficiency, providing a robust alternative to conventional methods. These technologies offer quicker, less labor-intensive, and more precise alternatives to classical approaches. Future research should focus on improving AI model reliability and generalizability to ensure widespread clinical adoption.

Background: The incidence of posterior malleolus fractures in ankle fractures ranges from 7% to 44%. Studies have indicated a poorer prognosis for ankle joint function when a posterior malleolar fracture is present, underscoring the significance of active intervention for optimal postoperative ankle function recovery. Hence, the selection of treatment for such fractures holds particular importance.

Objective: Screw fixation is a key treatment for posterior malleolus fractures (PMFs) or Haraguchi Type 1 fractures involving less than 25% of the distal tibia's articular surface. However, the optimal screw placement direction - anteroposterior (AP) or posterior-anterior (PA) - remains debated. This meta-analysis aims to compare these two approaches for treating posterior ankle fractures, focusing on the efficacy of PA fixation.

Methods: We searched the Cochrane Library, EMBASE, PubMed, SinoMed, and Web of Science databases from their inception to October 20, 2022. Methodological quality was assessed using the Cochrane Collaboration's tool for assessing bias risk in randomized controlled trials (RCTs). Stata MP17 software was used to compare the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, full weight-bearing time, and fracture healing time at the last follow-up between the two fixation methods.

Results: A total of 403 patients with posterior malleolar fractures from six RCTs met the inclusion criteria. The meta-analysis revealed a higher AOFAS score at the last follow-up for PA placement compared to AP placement [SMD = 0.512, 95% CI (0.244 to 0.780), z= 3.74, P< 0.001]. Postoperative full weight-bearing time and fracture healing time did not show statistically significant differences between the two groups.

Conclusion: PA fixation demonstrated a superior AOFAS score compared to AP fixation for posterior malleolar fractures. PA screw placement offers advantages in restoring ankle joint stability and enhancing joint function recovery post-surgery.

Background: Intensive care unit acquired weakness (ICU-AW) is a secondary neuromuscular complication in critically ill patients, characterized by profound weakness in all four limbs. Studies have shown that bundles of care are nursing strategies that combine a series of evidence-based interventions, which collectively optimize patients' clinical outcomes compared to individual interventions.

Objective: This study aims to conduct a meta-analysis of the effects of bundle interventions on ICU-AW deeply exploring the characteristics of bundle interventions, patient outcomes related to ICU-AW, and primarily investigating the effects of bundle interventions on ICU-AW. The main focus is to explore the clinical value of bundle interventions in treatment of ICU-acquired weakness in patients.

Methods: Computer and manual searches were conducted using keywords to retrieve relevant studies on the effects of bundle interventions on ICU-AW from databases such as PubMed, Web of Science, Cochrane Library and EMbase. The search period ranged from database inception to the present. The control group received standard ICU care, including basic nursing, while the intervention group received bundle nursing interventions.

Results: A total of 10 randomized controlled trials (RCTs) involving 1545 participants (790 in the intervention group and 755 in the control group) were included. Meta-analysis results showed that the intervention group had significantly higher muscle strength (MD = 7.41, 95% CI: 6.65-8.16, P< 0.00001) and daily living ability (MD = 34.01, 95% CI: 32.54-35.48, P< 0.00001) than the control group. Additionally, the incidence of ICU-AW (OR = 0.39, 95% CI: 0.26-0.59, P< 0.00001), mechanical ventilation time (MD =-3.71, 95% CI: -3.58∼-2.76, P< 0.0001), and ICU length of stay (MD =-2.73, 95% CI: -3.14∼-2.31, P< 0.00001) were significantly lower in the intervention group than in the control group.

Conclusion: ICU-AW has a severe negative impact on the recovery and functional restoration of ICU patients, increasing the treatment complexity for healthcare providers and the mortality and disability rates for patients. The bundled care approach may help reduce the incidence of ICU-AW, promote the restoration of daily activity function, enhance muscle strength, and reduce ICU stay and mechanical ventilation time for ICU patients. However, the long-term effects of bundle interventions still require further in-depth research.

Background: The human oral cavity contains over 700 types of bacteria that may protect the body against colonization by exogenous pathogens and maintain relative homeostasis. However, alterations in the immune status can disrupt the balance between microorganisms and the host, inducing various diseases such as oral cancer and diabetes mellitus. The mechanism underlying this process is not clearly understood.

Objective: The purpose of this study was to investigate the relationships between subgingival bacteria, T-cell receptor β-chain complementarity-determining region 3 (TCRβ CDR3), and the development oforal squamous cell carcinoma (OSCC).

Methods: We grouped patients as "healthy periodontal" (H), "moderate-to-severe chronic periodontitis" (C), and "moderate-to-severe chronic periodontitis with OSCC" (T). Bacterial groups were "subgingival plaque" (bp) and "gingival/tumor tissue" (g). We also recorded patients' age, gender, attachment level (AL), bleeding on probing (BOP), and probing depth (PD). We extracted and sequenced RNA from plaques, gingival tissues, tumors, and teeth. We performed high-throughput sequencing on TCRβ CDR3 and plaque bacteria.

Results: Synergistetes and Veillonella parvula were more abundant in the H group than in the T group. Granulicatella, Peptostreptococcus, and Streptococcus infantis were enriched in the T-bp group. AL, BOP, and PD were positively correlated with Granulicatella, Peptostreptococcus, and Pseudomonas but negatively correlated with Prevotella nigrescens and V. parvula. TCRβ CDR3 diversity was C > H > T. TCR β-chain Variable gene (TRBV)20-1 usage varied among the H, C, and T groups. TRBV2 and TRBV5-1 usage was greater in the T group than in the C group. TRBJ1-1, TRBJ1-2, TRBJ2-2, TRBJ2-7, and TRBJ2-5 were most frequently used.

Conclusions: These trends and the reduction of gingival Synergistetes were correlated with OSCC. TCRβ CDR3 diversity was the lowest in patients in the T group, and there were considerable changes in the expression of TRBV2 and TRBJ. Therefore, plaque bacterial composition can influence TCRβ CDR3.

Background: This study explores the influence of Diagnosis-Related Groups (DRG) payment reform on hospital cost control and offers pertinent cost management strategies for public hospitals. It situates the research by elucidating the significance of the DRG payment method and comparing its advantages and drawbacks with the traditional 'pay per project' model.

Objective: The primary aim is to assess the impact of DRG payment reform on hospital cost control and propose effective cost management strategies for public hospitals. The objective is to provide insights into DRG payment implications and attempt practical recommendations for its implementation in the public healthcare sector.

Methods: Employing a comprehensive approach, the study analyzes DRG payment, delineates advantages and drawbacks, and proposes cost management strategies. Methods include staff training, an information management platform, disease analysis, and optimized cost accounting. The study highlights the potential for improved medical diagnosis and treatment through industry-finance integration.

Results: Findings reveal advantages and limitations of DRG payment, emphasizing strategies for optimizing hospital operations. Enhanced medical diagnosis and treatment procedures through industry-finance integration contribute to overall cost control effectiveness.

Conclusion: The study serves as a practical guide for implementing DRG payment reforms, offering valuable insights for policymakers and healthcare professionals in navigating the complexities of cost control in public healthcare.

Background: Perioperative depth monitoring techniques, such as electroencephalography bispectral index (BIS), entropy index, and auditory evoked potential, are commonly used to assess anesthesia depth. However, the influence of patient positioning changes, particularly in gynecological surgeries where a head-down position is often required, on the accuracy of these monitoring indices remains unexplored.

Objective: The aim of the our study was to observe the impact of patient position changes on the monitoring value of entropy and BIS to identify a more sensitive method of anaesthesia depth monitoring for gynaecological surgery patients.

Methods: We conducted a study involving 40 women undergoing general anesthesia, during which routine monitoring of vital signs, including electrocardiogram (ECG), heart rate (HR), noninvasive arterial blood pressure (NIBP), oxyhemoglobin saturation (SpO2), and end-expiratory carbon dioxide (PetCO2), was initiated. Entropy and BIS devices were affixed to the patients' foreheads after alcohol sterilization to record brain activity. Tracheal intubation was performed following anesthesia induction. Throughout anesthesia maintenance, the value of BIS and response entropy (RE) were monitored and maintained between 40 and 50 by adjusting the infusion rate of propofol and remifentanil with Target Controlled Infusion (TCI, Mintopharmacokinetics model). Dosing for infusion control utilized corrected weight (height-105). Data were recorded before and after position changes, including tilting the operating table to head-down positions of 15 and 25 degrees, returning to a supine position, and elevating the head to 15 and 25-degree angles. BIS and entropy values at different time points were compared between the groups.

Results: Both BIS and entropy values increased from supine to head-down position and decreased from supine to head-up position, with entropy changes preceding those of BIS. Heart rate increased after head-up and decreased after head-down, while mean blood pressure (MBP) exhibited the opposite effect on heart rate. Significant correlations were found between heart rate and BIS (correlation coefficient: -0.43) and RE (correlation coefficient: -0.416), as well as between MBP and BIS (correlation coefficient: 0.346) and RE (correlation coefficient: 0.384).

Conclusion: Changes in patient position can significantly affect the value of RE and BIS, as changes in entropy occur earlier than changes in the BIS.

Background: Laparoscopic partial nephrectomy (LPN) is a standard surgical treatment option for renal tumors. Prior to LPN, it is necessary to evaluate the tumor condition and develop a surgical plan using precise imaging.

Objective: To explore the clinical application value of 3D virtual model (3DVM) in LPN.

Methods: A total of 80 patients with renal tumor who underwent LPN were measured. Patients were divided into three cohorts (A, B, C) according to the difficulty of surgery. Each group was further divided into the test and control groups based on the application of preoperative 3DVM. Surgical safety and efficacy were assessed, and a questionnaire was developed to investigate the opinions of patients and physicians on 3DVM.

Results: The duration of LPN and intraoperative renal artery occlusion were significantly different between the test and control groups in both cohorts A and B (P< 0.05). In cohort C, the surgical duration, duration of intraoperative renal artery occlusion, length of stay, time to postoperative ambulation, intraoperative bleeding, incidence of postoperative bleeding were significantly between the two groups (P< 0.05). The analysis both of patients and physicians questionnaire scores were statistically significant (P< 0.05).

Conclusions: 3DVM contributes to safer and more effective LPN. It benefits both doctors and patients.