代谢综合征对急性幕上皮质下腔隙性脑梗死患者短期预后的影响

目的 探讨代谢综合征(MS)对急性幕上皮质下腔隙性脑梗死患者短期认知功能和神经功能的影响。方法 回顾性分析2016年5月—2018年6月潍坊市人民医院神经内科收治的106例急性幕上皮质下腔隙性脑梗死患者的临床资料,根据是否患MS分为MS组46例和非MS组60例,以发病90 d的改良Rankin量表(mRS)评分≥3分为预后不良。所有患者行颅脑MRI检查,比较两组腔隙性梗死灶数量和Fazekas量表评分;比较两组入院及发病90 d的美国国立卫生研究院卒中量表(NIHSS)评分、蒙特利尔认知评估(MoCA)评分和mRS评分;比较两组的血生化指标。采用多因素一般Logistic回归分析短期预后不良的影响因素。结果 MS组患者的腰围、收缩压、舒张压、空腹血糖(FBG)、餐后2 h血糖(2 h PG)、腔隙性梗死灶数量、Fazekas量表评分高于非MS组(P <0.05),高密度脂蛋白胆固醇(HDL-C)低于非MS组(P <0.05)。MS组患者的入院NIHSS评分、入院mRS评分、发病90 d的NIHSS评分均高于非MS组(P <0.05),入院MoCA评分和发病90 d的MoCA评分均低于非MS组(P <0.05),两组发病90 d的mRS评分比较,差异无统计学意义(P>0.05)。多因素一般Logistic回归分析显示MS是急性幕上皮质下腔隙性脑梗死短期预后不良的独立影响因素[O^R=3.695(95%CI:1.288,10.600)]。结论 MS是急性幕上皮质下腔隙性脑梗死短期预后不良的独立影响因素,与脑卒中后神经功能损伤有关,可能与认知功能下降有关。

Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones

BACKGROUND Endoscopic sphincterotomy(EST) for the management of common bile duct stones(CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP) and accompanied by a higher recurrence of CBDS than open choledochotomy(OCT). Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date.AIM To compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence.METHODS Patients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study. Follow-up data were obtained through telephone or by searching the medical records. Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence. Propensity score matching(1:1) was performed to adjust for clinical differences. A logistic regression model was used to identify potential risk factors for recurrence, and a receiver operating characteristic(ROC)curve was generated for qualifying independent risk factors.RESULTS In total, 302 patients undergoing successful EST(n = 168) or OCT(n = 134) were enrolled in the study and were followed for a median of 6.3 years. After propensity score matching, 176 patients remained, and all covariates were balanced. EST was associated with significantly shorter time to relieving biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT(P <0.001). The number of complete stone clearance sessions increased significantly in the EST group(P = 0.009). The overall incidence of complications and mortality did not differ significantly between the two groups. Recurrent CBDS occurred in18.8%(33/176) of the patients overall, but no difference was found between the EST(20.5%, 18/88) and OCT(17.0%, 15/88) groups. Factors associated with CBDS recurrence included common bile duct(CBD) diameter > 15 mm(OR =2.72; 95%CI: 1.26-5.87; P = 0.011), multiple CBDS(OR = 5.09; 95%CI: 2.58-10.07; P< 0.001), and distal CBD angle ≤ 145°(OR = 2.92; 95%CI: 1.54-5.55; P = 0.001). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.81(95%CI: 0.76-0.87).CONCLUSION EST is superior to OCT with regard to time to biliary obstruction relief, anesthetic duration, procedure time, and hospital stay and is not associated with an increased recurrence rate or mortality compared with OCT in the management of CBDS.

Postoperative decrease of serum albumin predicts shortterm complications in patients undergoing gastric cancer resection

AIM To find an accurate and simple predictor for postoperative short-term complications after gastrectomy. METHODS Two hundred and twenty-three patients undergoing gastric cancer resection between October 1,2015 and September 30,2016 were enrolled in this study. Univariate and multivariate analyses were used toidentify risk factors for complications after gastrectomy. The cutoff values and diagnostic accuracy were examined by receiver operating characteristic curves.RESULTS Sixty-two(27.8%) patients had short-term complications after gastric cancer resection. The postoperative decrease in serum albumin(?ALB) was an independent risk factor for complications(OR = 17.957,95%CI: 6.073-53.095,P < 0.001). The cutoff value was 14.0% and the area under the curve was higher than that of C-reactive protein on postoperative day 3(area under the curve: 0.806 vs 0.709). Patients with ?ALB ≥ 14.0% were more likely to have short-term complications after gastrectomy(46.7% vs 5.0%,P < 0.001),prolonged hospital stay(17.2 ± 10.8 d vs 14.1 ± 4.2 d,P = 0.007) and higher comprehensive complication index(P < 0.001) than those with ?ALB < 14.0%.CONCLUSION Postoperative ?ALB with a cutoff of 14.0% can be used to recognize patients who have high risk of short-term complications following gastric cancer resection.

Age softening phenomenon and microscopic mechanism of Li−B alloy

The age softening phenomenon of the Li−B alloy was investigated by a series of tensile tests under various aging conditions.The results show that the tensile strength of the rolled Li−B alloy decreases with increasing aging time.Higher aging temperature accelerates the softening process,and leads to an early end of aging.A model was proposed to analyze the mechanism of the age softening.The vacancy annihilation is the control factor of age softening.The strength−temperature relationship was estimated by the newly proposed model and a standard heat treatment,annealing at 150℃ for 1 h,was designed to eliminate the age softening of rolled Li−B alloy.

The development of Electronic Health Literacy worldwide: a bibliometric analysis

Objective:This study aimed to review researches on electronic health literacy,provided some suggestions and identified directions for further research.Methods:The literatures were collected by searching the China National Knowledge Infrastructure(CNKI)and the core collection database of Web of Science from inception to November 17,2019.SPSS software was used for regression analysis,and citespace 5.5.R2 was used for visual analysis.Results:A total of 249 valid documents were retrieved,of which 205 were in English and 44 were in Chinese.Among them,USA had the largest number of publications,followed by Australia,Germany,Netherlands,and China.In China,Beijing has the most published literatures,followed by Anhui,Shanghai,Guangdong,and Shandong.The English-language journal with the most publications was journal of Medical Internet Research,and Chinese-language journal was Chinese health education.However,the Chinese and English core journals were relatively scattered,and no core journal group had yet formed.There were 111 funding institutions in both Chinese and English literature.Research content mainly included current situation investigation,influencing factors,clinical practice interventions,scale preparation and translation,qualitative interviews,etc.Conclusion:At present,there are many researches in the field of e-health literacy worldwide.However,the quality and depth of research still need to be further improved.The field of research also needs to be further expanded to meet the opportunities and challenges that the Internet brings to the medical industry.

The effects of Professional Commitment and Patient Safety knowledge-attitude-practice on Undergraduate nursing students’ Humanistic Care Ability in clinical practice

Objective:To describe the status quo of humanistic care ability,the knowledge-attitude-practice of Patient Safety and professional commitment among Undergraduate Nursing Students in clinical practice,and to determine the effects of professional commitment and patient safety knowledge-attitude-practice on humanistic care ability.Methods:Two hundred and thirty-two undergraduate nursing students in clinical practice were investigated with the general questionnaire,Caring Ability Inventory(CAI),Patients Safety knowledge-attitude-practice(KAP)Questionnaire and the Nursing Professional Commitment Scale.Results:The score of humanistic care ability of nursing undergraduates was 185.19±20.95,patients safety KAP score was 106.94±11.62,professional commitment score was 74.93±10.44.Undergraduate nursing students’humanistic care ability were positively correlated with professional commitment and patients safety KAP(P<0.05).Multiple Linear regression analysis showed that professional commitment,patient safety KAP entered the humane care equation(F=24.051,P<0.001),and explained 39.1%of the total variation in humane care.Intermediate effect analysis shows that patient safety played a partial mediating role in professional commitment and humane care.Conclusion:The professional commitment and patient safety KAP of undergraduate nursing students were positively related to their humanistic care ability.Improving the professional commitment and knowledge and patients safety KAP of nursing students can strengthen their humanistic care ability to provide high-quality nursing for patients.

Visual analysis of advance care planning related studies

Backgroud:To provide a reference for the further development of the field of the advance care planning(ACP),through the visual analysis of the related literature on the ACP.Methods:Taking the core collection database of Web of ScienceTM as data sources,the method of subject word retrieval is adopted.Literature metrology and CiteSpaceⅤinformation visualization software were used to analyze the literature on ACP published from inception to September 2019.Results:A total of 1,981 literature were included.The number of ACP studies increased,USA published the most literature in the world,followed by Australia,Britain,Canada and the Netherlands and so on.The most leading published journal was the Journal of Palliative Medicine,and the highest impact factor was Palliative Medicine(4.956).Sudore,Rebecca L and Hillary D Lum are the key researcher networks with the largest amount of articles published in ACP field.The research content mainly included the definition,implementation process and implementation effect of ACP.Research focused on palliative care,hospice care,decision-making,communication,patient preference and so on.Conclusion:The studies on ACP is on the rise,the research content is deepening,which suggests that we can learn from the research results of foreign countries in this field and continue to deepen the research in the field of ACP in China.

In situ formed three-dimensional (3D) lithium-boron(Li-B) alloy as a potential anode for next-generation lithium batteries

The practical application of the lithium anode in lithium metal batteries(LMBs) has been hindered by the uncontrollable growth of lithium dendrite and the high volumetric change during cycling. Herein, the in situ formed three-dimensional(3D) lithium-boron(Li-B) alloy is suggested as an excellent alternative to the Li metal, in which the 3D Li B skeleton can mitigate the growth of Li dendrites and volumetric change. In this study, the Li-B alloy anodes with different B contents were manufactured by high-temperature melting. It was found that the boron content had a significant effect on the electrochemical performance of the Li-B alloy. The Li-B alloy with the least B content(10 wt%, 10LiB) demonstrated the lowest overpotential of 0.0852 V after 300 h and the lowest interface resistance. However, the full cell with 15LiB as the anode displayed the best cycling performance of 115 m Ah·g^(-1) after 100 cycles with a columbic efficiency greater than 97%. The obtained results suggest that the in situ formed three-dimensional Li-B alloy anode can be an excellent alternative to the Li anode via tuning B contents for next-generation high energy density LMBs.