Effects of intensive psychological intervention on treatment compliance,psychological status,and quality of life of patients with epilepsy

BACKGROUND Epilepsy is a nervous system disease characterized by recurrent attacks,a long disease course,and an unfavorable prognosis.It is associated with an enduring therapeutic process,and finding a cure has been difficult.Patients with epilepsy are predisposed to adverse moods,such as resistance,anxiety,nervousness,and anxiety,which compromise treatment compliance and overall efficacy.AIM To explored the influence of intensive psychological intervention on treatment compliance,psychological status,and quality of life(QOL)of patients with epilepsy.METHODS The clinical data of 105 patients with epilepsy admitted between December 2019 and July 2023 were retrospectively analyzed,including those of 50 patients who underwent routine intervention(control group)and 55 who underwent intensive psychological intervention(research group).Treatment compliance,psychological status based on the Self-Rating Anxiety Scale(SAS)and Depression Scale Self-Rating Depression Scale(SDS)scores,hope level assessed using the Herth Hope Scale(HHS),psychological resilience evaluated using the Psychological Resilience Scale,and QOL determined using the QOL in Epilepsy-31 Inventory(QOLIE-31)were comparatively analyzed.RESULTS Treatment compliance in the research group was 85.5%,which is significantly better than the 68.0%of the control group.No notable intergroup differences in preinterventional SAS and SDS scores were identified(P>0.05);however,after the intervention,the SAS and SDS scores decreased significantly in the two groups,especially in the research group(P<0.05).The two groups also exhibited no significant differences in preinterventional HHS,Connor-Davidson Resilience Scale(CD-RISC),and QOLIE-31 scores(P>0.05).After 6 months of intervention,the research group showed evidently higher HHS,CD-RISC,tenacity,optimism,strength,and QOLIE-31 scores(P<0.05).CONCLUSION Intensive psychological intervention enhances treatment compliance,psychological status,and QOL of patients with epilepsy.

Intensive care unit-acquired weakness:Unveiling significant risk factors and preemptive strategies through machine learning

This editorial discusses an article recently published in the World Journal of Clinical Cases,focusing on risk factors associated with intensive care unit-acquired weak-ness(ICU-AW).ICU-AW is a serious neuromuscular complication seen in criti-cally ill patients,characterized by muscle dysfunction,weakness,and sensory impairments.Post-discharge,patients may encounter various obstacles impacting their quality of life.The pathogenesis involves intricate changes in muscle and nerve function,potentially leading to significant disabilities.Given its global significance,ICU-AW has become a key research area.The study identified critical risk factors using a multilayer perceptron neural network model,highlighting the impact of intensive care unit stay duration and mechanical ventilation duration on ICU-AW.Recommendations were provided for preventing ICU-AW,empha-sizing comprehensive interventions and risk factor mitigation.This editorial stresses the importance of external validation,cross-validation,and model tran-sparency to enhance model reliability.Moreover,the application of machine learning in clinical medicine has demonstrated clear benefits in improving disease understanding and treatment decisions.While machine learning presents oppor-tunities,challenges such as model reliability and data management necessitate thorough validation and ethical considerations.In conclusion,integrating ma-chine learning into healthcare offers significant potential and challenges.Enhan-cing data management,validating models,and upholding ethical standards are crucial for maximizing the benefits of machine learning in clinical practice.

Combined intensive preconditioning regimen allo-HSCT with imatinib for treatment of Ph chromosome positive acute lymphocyte leukemia

Objective To evaluate the outcome of combination of intensive preconditioning regimen allo - HSCT with imatinib for treatment of Ph chromosome positive acute lymphocyte leukemia ( ALL) . Methods Between 2009 and 2010,8 patients diagnosed as Ph + ALL received

Allocation of patients with liver cirrhosis and organ failure to intensive care: Systematic review and a proposal for clinical practice

AIM: To propose an allocation system of patients with liver cirrhosis to intensive care unit(ICU), and developed a decision tool for clinical practice. METHODS: A systematic review of the literature was performed in Pub Med, MEDLINE and EMBASE databases. The search includes studies on hospitalized patients with cirrhosis and organ failure, or acute on chronic liver failure and/or intensive care therapy. RESULTS: The initial search identified 660 potentially relevant articles. Ultimately, five articles were selected; two cohort studies and three reviews were found eligible. The literature on this topic is scarce and no studies specifically address allocation of patients with liver cirrhosis to ICU. Throughout the literature, there is consensus that selection criteria for ICU admission should be developed and validated for this group of patients and multidisciplinary approach is mandatory. Based on current available data we developed an algorithm, to determine if a patient is candidate to intensive care if needed, based on three scoring systems: premorbid Child-Pugh Score, Model of End stage Liver Disease score and the liver specific Sequential Organ Failure Assessment score.CONCLUSION: There are no established systems for allocation of patients with liver cirrhosis to the ICU and no evidence-based recommendations can be made.

Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy

Although many studies have investigated intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC),sample sizes in the reported studies are usually small and different in outcomes in different T and N subgroups are seldom analyzed.Herein,we evaluated the outcomes of NPC patients treated with IMRT and further explored treatment strategy to improve such outcome.We collected clinical data of 865 NPC patients treated with IMRT alone or in combination with chemotherapy,and classified all cases into the following prognostic categories according to different TNM stages:early stage group (T1-2N0-1M0),advanced local disease group (T3-4N0-1M0),advanced nodal disease group (T1-2N2-3M0),and advanced locoregional disease group (T3-4N2-3M0).The 5-year overall survival (OS),local relapse-free survival (LRFS),and distant metastases-free survival (DMFS) were 83.0%,90.4%,and 84.0%,respectively.The early disease group had the lowest treatment failure rate,with a 5-year OS of 95.6%.The advanced local disease group and advanced nodal disease group had similar failure pattern and treatment outcomes as well as similar hazard ratios for death (4.230 and 4.625,respectively).The advanced locoregional disease group had the highest incidence of relapse and death,with a 5-year DMFS and OS of 62.3% and 62.2%,respectively,and a hazard ratio for death of 10.402.Comparing with IMRT alone,IMRT in combination with chemotherapy provided no significant benefit to locoregionally advanced NPC.Our results suggest that the decision of treatment strategy for NPC patients should consider combinations of T and N stages,and that IMRT alone for early stage NPC patients can produce satisfactory results.However,for advanced local,nodal,and locoregional disease groups,a combination of chemotherapy and radiotherapy is recommended.

Determinants of Persistent Sputum Smear Positivity after Intensive Phase Chemotherapy among Patients with Tuberculosis at Rhodes Chest Clinic, Nairobi, Kenya

The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.

The Impact of Small Field’s Off-Set on Output Factor in Intensity Modulated Radiation Treatment

In intensity modulated radiation treatment (IMRT) planning, the use of asymmetrically collimated fields that are placed on central axis or its off-set is mostly required. Output is the main topic discussed today for extremely small and/or severe irregularly shaped fields. The air scatter data are involved directly or indirectly in obtaining the output. Despite the fact that extensive data have been published in many studies to provide a guide on the magnitude of output factor for clinical accelerators, there are very few data reviewed about output factor in-air or phantom for off-set fields. This study was aimed to investigate the impact of these conditions for small fields. This study was conducted in Elekta Synergy linear accelerator which produces 6 MV X-ray energy. The in-air output factor (Sc) has been measured by CC04 ion chamber with brass-alloy “build-up” cap and Dose-1 electrometer, and the total output (Scp) measurements were carried on at dose maximum depth in phantom by the same chamber and Thermoluminescence dosimeter (TLD) for 1 - 10 cm2 fields. The all measurements at center of isocenter and off-set fields at three directions (X2, Y1, Diagonal) were done. By decreasing field size from 10 to 2 cm2 at isocenter, the Sc value using CC04 was decreased to 5.4% and Scp using CC04 and TLD to 14.5% and 11% respectively. By increasing off-set value, the Sc and Scp values were increased in all directions comparing to central fields. The maximum increase was obtained in Y1 direction for Sc and Scp. TLD results for Scp is slightly higher than CC04. The dosimetric properties of small fields and their off-set should be evaluated and modelled appropriately in the treatment planning system to ensure accurate dose calculation in Intensity Modulated Radiation Treatment.

Correlation between current intensity and effective duration in the treatment of botulinus toxin for cerebral palsy by myoelectricity locating

BACKGROUND： Researches prove that the treatment of cerebral palsy by botulinus toxin （BTX-A） can improve effect and prolong effective duration. Current intensity is the important factor during injection. OBJECTIVE： To observe the changes of motor function and muscular intensity of children with spastic cerebral palsy after injecting BTX-A and analyze correlation between current intensity and effective duration. DESIGN： Cases control trial before and after nerves block SETTING： Capital University of Medical Sciences, China Rehabilitation Research Center PARTICIPANTS： From June 2002 to November 2004, 14 children with spastic cerebral palsy were treated by BTX-A block. All children were hospitalized in the Children Rehabilitation Department of China Rehabilitation Research Center. The children included 9 male and 5 female, and ranged from 4 to 13 years old, and average age was （6±2） years. Muscular tension ranged from grade 1 to grade 3. The diagnosis and the tape of cerebral palsy based on standard of the Fist Nationwide Cerebral Palsy Symposium, and all children were diagnosed with electroencephalogram （EEG）, CT and MRI, and permitted by their guardians. METHODS： （1） Locating and calculation： To locate block points by G6805-2A electro-therapeutic apparatus （Shanghai Huayi Electronic Instrument Plant） at the least stimulating current （continuous wave; impulse frequency; 2.667-83.333 Hz; current intensity： 0-6 mA; voltage： 6 V） to touch off muscles contraction. The current intensity of each point was recorded, and the average current intensity of each patient was calculated at the same time. （2） Dose of BTX-A： Basing upon the spastic degree and weight of patients, the dose was made certain： dose （IU）=（scores of Modified Ashworth Scale ＋2.5） xweight （kg）. The number of the block points was in all 4. The dose of injection ranged from 50 IU to 160 IU with the average of （73.6＋25.8） IU. The BTX-A was made by Lanzhou Institute of Biological Products, and each bottle contains 100 IU BTX-A. Muscular tension was evaluated by Modified Ashworth Scale. The scale ranged from grade 0 to grade 4, and the scores were from 0 to 4. The higher the scores were, the higher the muscular tension was. （3） Effect： Changes of muscular tension were evaluated by modified Ashworth Scale before and after block. Motor function was evaluated by Physician Rating Scale （PRS） before and after treatment. It contained Gait pattern, Hindfoot （ankle） position （stance-floor contact）, Hindfoot position （foot strike）, Knee position （degree of recurvation）, Crouch and Speed of gait. The scores ranged from 0 to 14. The higher the points were, the better the motor function was. （4） Effective duration： The duration was definited by the recovering of the Modified Ashworth Scale. （5） Statistic analysis： Firstly, the current intensity and the effect duration were analyzed by One-Sample Kolmogorov-Smirnov Test, the current intensity： Z= 0.456, P= 0.985, the effective duration： Z= 0.557, P= 0.915. Both data were normal distribution. Secondly, both data were analyzed by Linear Regression. The efficiency of the BTX-A block was analyzed by paired-samples t test. MAIN OUTCOME MEASURES： （1） Changes of motor function of muscular tension; （2） correlation between current intensity and effective duration. RESULTS： Fourteen children with spastic cerebral palsy were all involved in the final analysis. （1） Therapeutic effect： The average score of Ashworth scale after block was lower than that before block [（1.02±0.34） points vs. （2.12±0.48） points, t= 3.644, P〈 0.01]. The average score of RPS after block was higherthan that before block [（9.75±2.78） points vs. （6.16±0.58） points, t =13.222, P〈 0.01]. （2） Relation between the current intensity and the effective duration： The current intensity was （0.1857±0.0506） mA, and the effective duration was （26.36±4.48） weeks. The current intensity was negative correlation with effective duration （r = -0.775, P = 0.01 ）. CONCLUSION： （1） BTX-A occlusion can decrease muscular tension and improve motor function of lower limbs of children with spastic cerebral palsy. （2） The lower the current intensity is, the longer the effective duration is.

INFLUENCE OF DIFFERENT INTERVALS OF ACUPUNCTURE TREATMENT ON BONE INTENSITY IN PRIMARY OSTEOPOROSIS PATIENTS

Objective: To observe the influence of different intervals of acupuncture treatment on bone intensity in primary osteoporosis subjects. Methods: A total of 45 cases of primary osteoporosis female patients were randomly divided into 1 treatment/week (1-T/W), 2 treatments/week (2-T/W) and 3 treatments/week (3-T/W) groups, with 15 cases being in each group. Guanyuan (CV 4), Zusanli (ST 36), Sanyinjiao (SP 6), Shenshu (BL 23), Taixi (KI 3) and Pishu (BL 20) were used and stimulated with reinforcing needling manipulation. For patients with deficiency syndrome of kidney-yang, thermal acupuncture was applied to Shenshu (BL 23), and for patients with spleen-deficiency syndrome, thermal acupuncture applied to Zusanli (ST 36). Results: After 6 months’ treatment, in 1-T/W group, no apparent change of bone intensity was observed, while in 2-T/W and 3-T/W groups, the bone intensity was increased significantly (P<0.05, 0.01). Conclusion: Acupuncture plus moxibustion treatment twice or 3 times every week can obviously improve the bone intensity.

Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer:A treatment planning comparison

AIM： To compare the volumetric-modulated arc ther- apy （VMAT） plans with conventional sliding window intensity-modulated radiotherapy （c-IMRT） plans in esophageal cancer （EC）. METHODS： Twenty patients with EC were selected, including 5 cases located in the cervical, the upper, the middle and the lower thorax, respectively. Five plans were generated with the eclipse planning sys- tem： three using c-IMRT with 5 fields （5F）, 7 fields （7F） and 9 fields （gF）, and two using VMAT with a single arc （1A） and double arcs （2A）. The treatment plans were designed to deliver a dose of 60 Gy to the plan-ning target volume （PTV） with the same constrains in a 2.0 Gy daily fraction, 5 d a week. Plans were normal- ized to 95% of the PTV that received 100% of the pre- scribed dose. We examined the dose-volume histogram parameters of PTV and the organs at risk （OAR） such as lungs, spinal cord and heart. Monitor units （MU） and normal tissue complication probability （NTCP） of OAR were also reported. RESULTS： Both c-IMRT and VMAT plans resulted in abundant dose coverage of PTV for EC of different Io- cations. The dose conformity to PTV was improved as the number of field in c-IMRT or rotating arc in VMAT was increased. The doses to PTV and OAR in VMAT plans were not statistically different in comparison with c-IMRT plans, with the following exceptions： in cervical and upper thoracic EC, the conformity index （CI） was higher in VMAT （1A 0.78 and 2A 0.8） than in c-IMRT （5F 0.62, 7F 0.66 and 9F 0.73） and homogeneity was slightly better in c-IMRT （7F 1.09 and 9F 1.07） than in VMAT （1A 1,1 and 2A 1.09）, Lung V30 was lower in VMAT （1A 12.52 and 2A 12.29） than in c-IMRT （7F 14.35 and 9F 14.81）. The humeral head doses were significantly increased in VMAT as against c-IMRT. In the middle and lower thoracic EC, CI in VMAT （1A 0.76 and 2A 0.74） was higher than in c-IMRT （5F 0.63 Gy and 7F 0.67 Gy）, and homogeneity was almost similar between VMAT and c-IMRT. V20 （2A 21.49 Gy vs 7F 24.59 Gy and 9F 24.16 Gy） and V30 （2A 9.73 Gy vs 5F 12.61 Gy, 7F 11.5 Gy and 9F 11.37 Gy） of lungs in VMAT were lower than in c-IMRT, but low doses to lungs （V5 and Vl0） were increased. V30 （1A 48.12 Gy vs 5F 59.2 Gy, 7F 58.59 Gy and 9F 57.2 Gy）, V40 and V50 of heart in VMAT was lower than in c-IMRT. MUs in VMAT plans were significantly reduced in comparison with c-IMRT, maximum doses to the spinal cord and mean doses of lungs were similar between the two techniques. NTCP of spinal cord was 0 for all cases. NTCP of lungs and heart in VMAT were lower than in c-IMRT. The advantage of VMAT plan was enhanced by doubling the arc. CONCLUSION： Compared with c-IMRT, VMAT, especial- ly the 2A, slightly improves the OAR dose sparing, such as lungs and heart, and reduces NTCP and MU with a better PTV coverage.

Sonablate-500^(TM) Transrectal High-intensity Focused Ultrasound (HIFU) for Benign Prostatic Hyperplasia Patients

To evaluate the safety and efficacy of transrectal high-intensity focused ultrasound （HIFU） in the treatment of benign prostatic hyperplasia （BPH）, serial studies were conducted in 150 BPH patients before and 30 min, 1, 2, 6 and 12 month（s） after Sonablate-500TM HIFU treatment. A silicon-coated indwelling 16F latex catheter was placed during the determination of the therapy zone. Preoperative and postoperative evaluations were made by using the international prostate symptom score （IPSS）, quality of life （QOL）, uroflowmetric findings and transrectal ultrasound, and incidence of complications. The cystourethrography was done in 23 patients within 1 year postoperatively. The results showed that after HIFU treatment, IPSS and QOL scores were significantly decreased at 1, 2, 6 and 12 month（s） （P〈0.01）. Maximum urine flow rate （6.0 to 17.2 mL/s, P〈0.01）, PVR （75.0 to 30.3, P〈0.01） and prostatic volume （65.0 to 38.1 mL, P〈0.05） were significantly improved 12 months after the operation. Recurrent urinary retention （17=2） and urethrorectal fistula （n=1） occurred at the 15th postoperative day. The duration of the HIFU prostate ablation was 25-90 min. The mean time for an indwelling catheter was 3-19 days. These data demonstrate that treatment of BPH with Sonab- late-500TM HIFU is safe and effective.

Characteristics of Electrode-Water-Electrode Discharge and its Application to Water Treatment

Atmospheric air discharge above the surface of water is an effective method for water treatment.The leakage current and Joule heating of water are reduced by the air gap,which raises the energy efficiency of the water treatment.However,the application of this kind of discharge is limited by a pair of conflicting factors：the chemical efficiency grows as the discharge gap distance decreases,while the spark breakdown voltage decreases as the gap distance decreases.To raise the spark breakdown voltage and the chemical efficiency of atmospheric pressure water surface discharge,both the high-voltage electrode and the ground electrode are suspended above the water surface to form an electrode-water-electrode discharge system.For this system,there are two potential discharge directions：from one electrode to another directly,and from the electrodes to the water surface.The first step in utilizing the electrode-water-electrode discharge is to find out the discharge direction transition criterion.In this paper,the discharge direction transition criterions of spark discharge and streamer discharge are presented.By comparing the discharge characteristics and the chemical efficiencies,the discharge propagating from the electrodes to the water surface is proved to be more suitable for water treatment than that propagating directly between the electrodes.

Intended process water management concept for the mechanical biological treatment of municipal solid waste

Accumulating operational experience in both aerobic and anaerobic mechanical biological waste treatment （MBT） makes it increasingly obvious that controlled water management would substantially reduce the cost of MBT and also enhance resource recovery of the organic and inorganic fraction. The MBT plant at Gescher, Germany, is used as an example in order to determine the quantity and composition of process water and leachates from intensive and subsequent rotting, pressing water from anaerobic digestion and scrubber water from acid exhaust air treatment, and hence prepare an MBT water balance. The potential of, requirements for and limits to internal process water reuse as well as the possibilities of resource recovery from scrubber water are also examined. Finally, an assimilated process water management concept with the purpose of an extensive reduction of wastewater quantity and freshwater demand is presented.

Time difference based measurement of ultrasonic cavitations in wastewater treatment

Intensity of cavitation is significant in ultrasonic wastewater treatment,but is complicated to measure.A time difference based method of ultrasonic cavitation measurement is proposed.The time differences at different powers of 495 kHz ultrasonic are measured in experiment in comparison with conductimetric method.Simulation results show that time difference and electrical conductivity are both approximately positive proportional to the ultrasonic power.The degradation of PNP solution verifies the availability in wastewater treatment by using ultrasonic.

Effect of Heat Treatment Conditions on Photo sensitivity of CdSexS1-x Polycrystalline Films

The influence of thermal treatment on the lux-ampere characteristics of polycrystalline films from the CdSexS1-x solid solution obtained by the method of thermal evaporation in a vacuum has been investigated. It is shown that at low illumination intensities L μ of electrons increases with a power law μ ~ Lγ, first with the exponent γ > 1, then with γ ≈ 0.5, and their concentration n almost does not change. Starting from the intensity L > 12 - 15 lx, the electron concentration increases strongly n ~ Lβ from β ≈ 3.0, and the parameters n and μ reach relatively high values ~(1015 - 1016) sm-3 and ~(150 - 200) sm2/V·s, however further, at L > 50 lx, a weak dependence of n(L) and μ(L) with β, γ < 1.0 is found. The obtained experimental results are interpreted on the basis of a model of a semiconductor film with intergranular potential barriers when the concentration and barrier mechanisms of photoconductivity operate simultaneously.

Long-Term Outcomes and Prognosis of Transrectal High-Intensity Focused Ultrasound Therapy for Patients with Localized Prostate Cancer—Therapy after Recurrence and Predictive Factors

Objectives: To evaluate the outcomes and prognosis of high-intensity focused ultrasound (HIFU) therapy for patients with localized prostate cancer, and identify suitable candidates for this therapy by investigating the predictive factors. Methods: The 224 patients (low 54, intermediate 111 and high-risk patients 59) with T1-2 stage were treated using the Sonablate device and followed for over 12 months after treatment. Recurrence was determined based on histological findings, prostate-specific antigen (PSA) failure and local or distant metastasis. The factors which are predicting variables with potential effects were investigated by Kaplan-Meier and multivariate analysis. Results: A total of 255 treatment sessions (193 with one, 31 with two) were performed. No patients died of prostate cancer, but 15 died of other causes and 14 patients were lost during follow-up. The 7-year recurrence-free survival (RFS) rates in all patients were 75%, and 5-year RFS rates were 98%, 84% and 59% in the low, intermediate and high-risk patients respectively. In the 216 patients who underwent histological examination at 6 months or later after HIFU, 25 (12%) were positive. In 77 patients with recurrence after first-HIFU, the second treatments were hormonal therapy and HIFU. Of the 31 patients who underwent a second HIFU, the 5-year RFS rates were 64%, and 5-year RFS rates were 100%, 74% and 33% in the low, intermediate and high-risk patients. The significant predictor for recurrence was risk-group, T-stage (T1 vs T2), Gleason score (≤3 + 4 and ≥4 + 3), pretreatment PSA (Conclusions: Prognosis of HIFU for Patients with localized prostate cancer was good, and the low and intermediate-risk patients with T1-staging are suitable indications for HIFU. Effective predictors for outcomes were risk-group, T-stage, Gleason score, pretreatment PSA and nadir PSA.

DIP付费对医疗服务项目诊疗强度的影响研究

目的:探索DIP付费对医疗服务项目诊疗强度的影响。方法:收集某市2020年1月至2022年12月330家医疗机构住院患者开展数字化摄影诊疗的数据,利用独立样本t检验比较诊疗强度的变化,采用间断时间序列分析考察DIP付费对诊疗强度的影响。结果:DIP付费后三级医院、一级医院数字化摄影诊疗强度分别增加了0.03和0.04,二级医院下降了0.06;三级医院诊疗强度在短期内增加(β_(2)=0.061),长期却呈现下降趋势(β_(3)=-0.007)。结论:DIP付费对医疗服务项目诊疗强度的政策效应可能与政策预期不一致,异质性和同质性并存;要强化DIP支付方式改革与医疗服务价格改革的协同路径。

Lax Facial Skin Treated with High-Intensity Focused Ultrasound Devices: Efficacy and Safety Evaluations

Background: High-intensity focused ultrasound (HIFU) has been introduced to improve skin laxity in recent years. However, very few studies have evaluated the safety and effectiveness of HIFU in Chinese populations. Methods: In the study, 30 Chinese participants underwent HIFU (Bolida, Inc., Changsha, China) rejuvenation between February 1, 2022, and September 30, 2022. There were three different focal depths used depending on the area where shots were captured (4.5 mm, 4 MHz;3 mm, 7 MHz;1.5 mm, 7 MHz). After 3 months and 6 months of treatment, efficacy and safety were assessed by quantitative analysis. Results: Patients were satisfied with the clinical effects of HIFU rejuvenation after one session. In terms of effectiveness, HIFU was most successful in areas around the jawline, cheek, and perioral. In four cases, erythema was observed, in two cases, swollen gums were seen, but all of these effects were transient and mild. Conclusion: Bolida system can be safe and effective for facial tightening, additionally, they are most effective for jawline, cheek, and perioral improvements. In clinical practice, the Bolida system can be recommended as a reliable treatment option. .

某大型综合医院神经外科重症监护患者营养治疗实施状况分析

目的:分析南通大学附属医院神经外科重症监护病房(neurosurgery intensive care unit,NICU)收治患者的营养治疗现状。方法:以2022年1月—2023年1月入住南通大学附属医院NICU的患者为调查对象,收集患者基本信息和临床指标,包括营养风险筛查评分(nutrition risk score 2002,NRS 2002)、危重症营养风险评分(nutrition risk score in the critically ill,NUTRIC)、胃肠功能损伤分级、营养治疗实施的时机和途径、入病房第1、3和7天热卡及蛋白达标情况、喂养耐受情况以及患者的28 d临床转归情况。结果:调查共收集患者133例,平均年龄(58.3±15.4)岁。患者格拉斯哥昏迷评分、序贯器官衰竭评分和急性生理与慢性健康评分分别为(4.07±2.41)、(7.10±2.59)、(11.0±3.4)分。28 d临床转归存活100例(75.2%),死亡33例(14.8%)。除BMI(P=0.0192)外,男性与女性患者在年龄、病情严重程度方面差异均无统计学意义(均P>0.05)。133例患者中,胃肠功能正常或轻度损害95例(71.4%),中-重度损害29例(21.8%),衰竭8例(6.0%)。入NICU 24 h内即开始肠内营养(enteral nutrition,EN)患者82例(61.7%)。72 h内达到20 kcal/(kg·d)的热卡目标的有28例(31.5%),1周总热卡达标率为12.3%(11/89),达到80%蛋白质喂养目标的有5例(3.76%)。高营养风险组的白蛋白水平在入NICU第7天显著低于低营养风险组。结论:目前我院NICU内超过70%的患者在48 h内接受EN治疗,喂养期间出现最多的不耐受症状是腹胀。补充性肠外营养的比例、1周左右的热卡及蛋白达标率均较低。应加强个性化制定热卡和蛋白目标进行营养补充。

经直肠超声造影评估前列腺癌新辅助内分泌治疗反应的价值

目的:探讨经直肠超声造影(contrast-enhanced transrectal ultrasound)时间-强度曲线(time-intensity curve,TIC)参数评估前列腺癌(prostate cancer,PCa)患者对新辅助内分泌治疗(neoadjuvant hormonal therapy,NHT)的反应程度。方法:纳入27例接受NHT的PCa患者的临床资料,根据术后病理学检查结果分为有效组(n=16)和无效组(n=11)。对比两组患者临床病理学特征、治疗前后血清前列腺特异性抗原(prostate-specific antigen,PSA)和CETRUS检查指标及其变化率,以筛选与NHT反应性有关的潜在指标。进一步采用相关性分析评价其在评估患者对NHT反应方面的价值。结果:有效组和无效组在临床病理学特征、治疗前的血清PSA和C E T R U S检查指标方面的差异无统计学意义(均P>0.05)。治疗后,仅有效组的TIC曲线下面积(area under curve,AUC)低于无效组(560 dB·s vs 710 dB·s),其变化率大于无效组(-27.1%vs-5.3%)(均P<0.05)。相关性分析显示AUC变化率与组织学反应评分之间的相关性略高于治疗后AUC(r为-0.690 vs-0.630)。结论:CETRUS TIC参数中,NHT后的AUC及其变化率在评估PCa患者对NHT反应方面具有较好的价值。其中,AUC变化率可能与治疗反应程度更相关。