Technology and Health Care最新文献

Background: non-small cell lung cancer (NSCLC) accounts for more than 80% of all lung cancer populations. Stereotactic radiotherapy (SBRT) is mainly suitable for early NSCLC patients who are not suitable for surgery or refuse surgery.

Objective: To analyze the effects of stereotactic radiotherapy (SBRT) plus immunotherapy for non-small cell lung cancer (NSCLC) patients on their immune status and survival quality.

Methods: NSCLC patients admitted to our hospital from 2019-2022 were divided into 61 cases in control group (SBRT) and 60 cases in observation group (SBRT plus immunotherapy) by the randomized numerical table method to compare the efficacy, the level of tumor markers in the serum, the level and activity of the immune cells in the peripheral blood and the Kahlil's functional status (KPS) scores.

Results: The observation group had a higher efficacy rate than that of the control group (P< 0.05). There was no statistical difference between the two groups in serum tumor marker content, immune cell level and activity in peripheral blood and KPS score before treatment (P> 0.05). After treatment, serum tumor markers were lower than those in control group, and immune cell level, NK cell-related activity and KPS score were higher than those in control group (P< 0.05).

Conclusion: SBRT plus immunotherapy can reduce the level of various tumor markers, improve the immune status and quality of survival for NSCLC patients.

Background: Fiber post (FP) reinforced restoration was widespread in endodontically treated teeth, of which the retention was closely related to fit and operation process. However, the question whether the fit and self-etching adhesive (SED) affect the success of FP restoration still remained unclear.

Objective: This research aimed to assess how the fit and self-etching adhesive (SED) impact the pull-out bond strength (BS) of glass fiber-reinforced composite posts from the root canal dentin.

Methods: Eighty lower first premolars underwent simulated endodontic treatment, after which their canals were shaped to accommodate a size three RelyX fiber post (FP) (diameter 1.9 mm). They were then divided into 4 equal groups [Unfit post and no SEA (Group UN), Fit post and no SEA (Group FN), Unfit post with SEA (Group UA) and Fit post with SEA (Group FA)] using two different sized FPs and SEA. Cement thickness was acquired by histological analysis and stereomicroscopy. Each sample was tested for pull-out strength through a universal testing machine. Based on the pull-out test, the failure types were observed and scored by visualizing through a stereomicroscope.

Results: Group FA demonstrated significantly greater BS compared to Group UN and Group UA, with Group UN showing a statistically significant difference at p< 0.01 and Group UA at p< 0.05. Main failure types in Group FA were Type II, which illustrated that the cement detachment mainly occurred from the post-cement interface. Therefore, Group FA possessed the STRONGEST BS and was most suitable for FP-reinforced crown restorations.

Conclusions: Both the fit and SEA enhanced the pull-out BS. The SEA was critical for BS promotion when the mechanical retention was inadequate.

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: Presurgical planning of the correction angle plays a decisive role in a high tibial osteotomy, affecting the loading situation in the knee affected by osteoarthritis. The planning approach by Fujisawa et al. aims to adjust the weight-bearing line to achieve an optimal knee joint load distribution. While this method is accessible, it may not fully consider the complexity of individual dynamic knee-loading profiles. This review aims to disclose existing alternative HTO planning methods that do not follow Fujisawa's standard.

Methods: PubMed, Web of Science and CENTRAL databases were screened, focusing on HTO research in combination with alternative planning approaches.

Results: Eight out of 828 studies were included, with seven simulation studies based on finite element analysis and multi-body dynamics. The planning approaches incorporated gradual degrees of realignment parameters (weight-bearing line shift, medial proximal tibial angle, hip-knee-ankle, knee joint line orientation), simulating their effect on knee kinematics, contact force/stress, Von Mises and shear stress. Two studies proposed implementing individual correction magnitudes derived from preoperatively predicted knee adduction moments.

Conclusion: Most planning methods depend on static alignment assessments, neglecting an adequate loading-depending profile. They are confined to their conceptual phases, making the associated planning methods unviable for current clinical use.

Background: Stroke, a leading cause of health impairment globally, sees intravenous thrombolysis as the primary treatment during the acute phase, yet delays persist due to pre-hospital and in-hospital factors. While research has reduced in-hospital delays significantly, pre-hospital delays remain a concern both domestically and internationally.

Objective: This article aims to provide a comprehensive review of the research progress on the influencing factors and intervention measures of pre-hospital delays in acute ischemic stroke.

Methods: By analyzing the literature, summarize the risk factors leading to treatment delay in acute ischemic stroke (AIS), and provide a review of potential improvement methods.

Results: Pre-hospital delay in acute ischemic stroke (AIS) is influenced by both objective factors like age, gender, and regional economic status, as well as subjective factors such as stroke awareness. The introduction of "Stroke 120," a stroke education slogan tailored to Chinese language habits, aims to improve stroke awareness and address delayed treatment and low AIS venous thrombolysis utilization among the Chinese public.

Conclusion: In conclusion, collaborative efforts from the government, society, and hospitals are essential to enhance stroke education comprehensively. This will ensure widespread awareness of stroke knowledge, facilitating timely and effective treatment for AIS patients.

Background: Uterine fibroids, benign smooth muscle tumors prevalent in the female genital tract, affecting up to 40% of women of childbearing age. High-intensity focused ultrasound (HIFU) has emerged as a promising non-invasive approach for treating uterine fibroids, but some patients may still experience recurrence of uterine fibroids after treatment.

Objective: This study aims to explore the risk factors associated with uterine fibroid recurrence following HIFU treatment, and to provide a basis for formulating response measures to prevent uterine fibroid recurrence after surgery in clinical practice.

Methods: In this regression observational study, 120 patients with uterine fibroids who underwent HIFU therapy at our institution from Jan 2018 to Dec 2021 were included as the study subjects. Collect clinical data of all included patients, and follow up for a total of 2 years every 6 menstrual periods with gynecological ultrasound or related examinations after surgery. Univariate and logistic regression analyses were performed to identify risk factors for recurrence in potential uterine fibroid patients receiving HIFU knife treatment.

Results: Patients were divided into a relapse group (n = 27) and a non-relapse group (n = 93) based on recurrence during the follow-up period. The outcome of univariate analysis indicated no statistically significant difference in age, BMI, age at menarche, history of preoperative pregnancy, history of postoperative pregnancy, family history of uterine fibroids, Bcl-2, FSH, LH, E2, PRL, P, and T between the two groups (p > 0.05). Notably, significant differences were observed in fibroid diameter, ER, and PR (p < 0.05). Logistic regression analysis revealed uterine fibroid diameter (OR = 28.032, 6.074 ∼ 129.372), PR (OR = 4.642, 2.382 ∼ 9.049), and ER (OR = 3.435, 1.820 ∼ 6.483) were independent risk factors for uterine fibroid recurrence after HIFU knife treatment. ROC curve analysis showed that the AUC of uterine fibroid recurrence predicted by fibroid diameter, ER, and PR after HIFU knife treatment were 0.791, 0.738, and 0.785, respectively.

Conclusion: The diameter, ER, and PR of uterine fibroids are closely related to the recurrence of uterine fibroids after surgical treatment, and it is worth implementing key perioperative management in clinical practice to prevent and manage the recurrence of uterine fibroids.

Background: To explore the predictive value of the modified NUTrition Risk in the Critically ill (mNUTRIC) for patients with sepsis and acute respiratory distress syndrome (ARDS) developing into chronic critical illness (CCI).

Methods: A retrospective observational study was conducted on 118 patients admitted to the Intensive Care Unit (ICU) of Yiwu Central Hospital from January 2020 to May 2022. Patients were categorized into two groups: CCI and rapid recovery (RAP), based on the occurrence of CCI. Age, gender, white blood cell count, C-reactive protein, albumin, serum creatinine, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), mNUTRIC score, ICU length of stay, mechanical ventilation duration, and continuous renal replacement therapy (CRRT) were compared between the two groups. The association between mNUTRIC and CCI in patients with sepsis complicated by ARDS was further examined using three models and multivariate logistic regression.The receiver operating characteristic (ROC) curve was utilized to analyze the predictive values of mNUTRIC score, SOFA score, and APACHE II score for predicting the occurrence of CCI in patients with sepsis complicated by ARDS.

Results: The age, mNUTRIC score, SOFA score, APACHE II score, ICU length of stay, mechanical ventilation duration, and CRRT ratio were significantly higher in the CCI group compared to the RAP group (all P < 0.05). Conversely, there were no statistically significant differences in white blood cell count, C-reactive protein, and albumin levels between the two groups (all P > 0.05). Multivariate logistic regression analysis identified the mNUTRIC score as an independent risk factor for CCI in patients with sepsis complicated by ARDS. The constructed models showed that the mNUTRIC score remained significant, while the SOFA score and APACHE II score did not.The area under the ROC curve analysis demonstrated that the mNUTRIC score had the highest AUC of 0.880, 95% Confidence Interval (CI): 0.808-0.933. The AUC for the SOFA score was 0.864, and for the APACHE II score was 0.825, all of which were statistically significant.

Conclusions: The mNUTRIC score is valuable in predicting the progression of sepsis combined with ARDS to CCI, and may even be superior to the SOFA score and APACHE II score.

Background: The rising incidence of ectopic pregnancy (EP) in China underscores the critical need for early and accurate diagnosis to achieve optimal patient outcomes. Colour Doppler ultrasound, β-hCG, and progesterone testing are essential tools in the detection of EP, with transvaginal ultrasound offering precise visualization of EP lesions. Lower levels of β-hCG and progesterone in EP cases compared to normal pregnancies serve as key diagnostic markers. Awareness of atypical symptoms is crucial to prevent missed or misdiagnosed cases, underscoring the importance of timely intervention to mitigate severe complications.

Objective: To investigate the differences in colour Doppler ultrasound findings, serum β-hCG levels, and progesterone levels between normal and ectopic pregnancies, in order to provide insights into the clinical diagnosis and treatment of EP.

Methods: Sixty patients who showed no gestational sac in the uterus during early pregnancy and were either highly suspected or pathologically confirmed to have EP were selected for this study. As controls, fifty women with normal pregnancies during the same period were also included. Colour Doppler ultrasound findings (endometrial thickness, pelvic effusion, uterine effusion, and adnexal mass), serum β-hCG levels, and progesterone levels were recorded and compared between the two groups.

Results: Colour Doppler ultrasound showed that the EP group had significantly greater incidences of pelvic effusion, uterine effusion, and an adnexal mass than did the control group. Moreover, the EP patients had significantly thinner endometria (8.3 ± 3.37 mm vs. 16.12 ± 3.09 mm; P < 0.05), lower serum β-hCG levels (846.18-1444.09 vs. 2429.24-3020.56; P < 0.05), and lower progesterone levels (9.1 ± 7.19 vs. 17.66 ± 5.63; P < 0.05) than did the controls. Receiver operating characteristic (ROC) analysis revealed that endometrial thickness, serum β-hCG concentration, and progesterone concentration had considerably high area under the curve (AUC), sensitivity, and specificity for the diagnosis of EP.

Conclusion: Colour Doppler ultrasound, serum β-hCG concentration, and progesterone concentration have high diagnostic value for EP.

Objective: The impact of the intrathecal infusion port system on patients with advanced cancer pain and the nursing workload on their primary caregivers was investigated in this study.

Methods: Between January 2018 and December 2021, a total of 26 patients with advanced cancer pain who received intrathecal infusion in our hospital, were enrolled in this study along with their primary caregivers. Assessments of patients' pain levels, adverse reactions, and quality of life, as well as the nursing workload of primary caregivers were evaluated.

Results: The findings revealed a significant reduction in pain scores, decreasing from (7.42 ± 0.58) one week before treatment to (2.00 ± 0.56) one week after treatment, and maintaining a similar level at (2.07 ± 0.56) one month post-treatment, with a concomitant decrease in associated complications. Moreover, an improvement in overall quality of life was observed, as evident in the total physical health scores, which increased from (33.97 ± 7.14) one week prior to treatment to (47.44 ± 10.14) one week post-treatment and (48.56 ± 9.35) one month post-treatment. The total psychological health scores exhibited a positive trajectory, rising from (52.50 ± 23.55) one week before treatment to (65.00 ± 16.55) one week after treatment, ultimately reaching (69.42 ± 15.64) one month post-treatment. Furthermore, the primary caregivers' nursing workload experienced a consistent decline, decreasing from (51.54 ± 7.30) one week before treatment to (46.54 ± 5.57) one week after treatment and further diminishing to (45.32 ± 6.41) one month after treatment. Repeated measures of variance showed that there were significant differences in pain, quality of life, and primary caregivers' nursing workload at different time points (P < 0.05).

Conclusion: The intrathecal infusion port system can effectively reduce the pain level of patients with advanced cancer pain, improve their quality of life, and reduce the nursing workload of their primary caregivers.

Background: Deep neural networks (DNNs) have recently been significantly applied to automatic arrhythmia classification. However, their classification accuracy still has room for improvement.

Objectives: The aim of this study is to address the existing limitations in current models by developing a more effective approach for automatic arrhythmia classification. The specific objectives include enhancing the receptive field sizes to capture more detailed information across various temporal scales, and incorporating inter-channel correlations to improve the feature extraction process.

Methods: This study proposes a pyramidal dense connectivity layer and bidirectional long short-term memory network (PDC-BiLSTM) to effectively extract waveform features across various temporal scales, which can capture the intricate details and the broader global information in the signals through a wide range of sensory fields. The efficient channel attention (ECA) is additionally introduced to dynamically allocate weights to each feature channel, assisting the model inefficiently prioritizing essential characteristics during the training process.

Results: The experimental results on the MIT-BIH arrhythmia database showed that the overall classification accuracy of the proposed method under the intra-patient paradigm reached 99.82%, and the positive predictive value, sensitivity and F1 Score were 99.64%, 97.61% and 98.60% respectively; under the inter-patient paradigm, the overall accuracy was 96.30%.

Conclusion: Compared with the latest research results in this field, the proposed model is also better than the existing models in terms of accuracy, which has the potential value of being applied to devices that assist in diagnosing cardiovascular diseases.