EDITOR'S NOTE:The author wasblessed with a rarechance to be with31 Living Buddhas,kampo abbots andsutra teaches-hail-ing from Tibet andthe areas inhabitedby the Tibetans inSichuan,Qinghai,Gansu and YunnanProvince...EDITOR'S NOTE:The author wasblessed with a rarechance to be with31 Living Buddhas,kampo abbots andsutra teaches-hail-ing from Tibet andthe areas inhabitedby the Tibetans inSichuan,Qinghai,Gansu and YunnanProvinces,andrecorded the follow-ing stories．展开更多
The Double Take column looks at a single topic from an African and Chinese perspective. This month we discuss whether the advent of social media brings relationships closer or moves them farther apart.
The advantage of being a late follower is not forever In 2016 China made $5.5 trillion worth of mobile payments while the United States made $112 billion.China is far ahead of Western countries in
Staying healthy is important,but many people neglect(忽视)their health because they don’t think they have the time to look after it.It’s not just a time matter;people think it’s boring to spend time on their health...Staying healthy is important,but many people neglect(忽视)their health because they don’t think they have the time to look after it.It’s not just a time matter;people think it’s boring to spend time on their health.In fact,you can do some simple things to get healthier and have fun.There are some fun things that hardly seem like they are for keeping you healthy展开更多
This paper investigates the staying and moving characteristics of office workers in a non-territorial office using an ultra wide band(UWB)impulse radio sensor network.The differences between office workers’staying an...This paper investigates the staying and moving characteristics of office workers in a non-territorial office using an ultra wide band(UWB)impulse radio sensor network.The differences between office workers’staying and moving are clarified according to the individual workstation type that they select.The study determines the characteristics of each type of workstation.By clarifying office workers’preference for staying and moving with regard to individual workstation types and office worker post,the reasons why office workers in different posts tended to select different types of workstations were revealed.Specifically,leaders tended to select workstations at the“inner meeting corner side”most frequently,as they had a greater need to stay in other areas.In contrast,ordinary staff needed to visit office workers in other areas less often,and as such,they tended to select individual workstations at the“middle meeting corner side.”Barring this,they tended to select individual workstations at the“middle corridor side”or“outer-meeting corner side.”Temporary staff members had little need to visit or stay at other places so they tended to select individual workstations at the“window side,”which is seldom visited or stayed at by other office workers and they could be disturbed less often from their solo work.展开更多
The annual sessions of the 13th National People's Congress and the 13th National Committee of the Chinese People's Political Consultative Conference, or Two Sessions, that concluded in mid March reflected a ge...The annual sessions of the 13th National People's Congress and the 13th National Committee of the Chinese People's Political Consultative Conference, or Two Sessions, that concluded in mid March reflected a general acknowledgement in Beijing that some of the great challenges expected to emerge in the new era have already surfaced, not necessarily sooner than anticipated, but in a difficult combination.展开更多
Right in the middle of the deepe ning U.S.-China trade war storm, Huawei Technologies Co.,the world's leading telecom network equipment provider from Chin a, is maki ng world headlines as a result of the U.S. ban ...Right in the middle of the deepe ning U.S.-China trade war storm, Huawei Technologies Co.,the world's leading telecom network equipment provider from Chin a, is maki ng world headlines as a result of the U.S. ban on its products and cutoff from its business partners. During an exclusive interview with state broadcaster China Central Television (CCTV) on May 21, Huawei founder and CEO Ren Zhengfei showed little concern about the challenges facing the company.展开更多
Hu Jintao, Chinese President and General Secretary of the Communist Party of China (CPC) Central Committee, on June 25 once again stressed the importance of implementing the scientific concept of development, promotin...Hu Jintao, Chinese President and General Secretary of the Communist Party of China (CPC) Central Committee, on June 25 once again stressed the importance of implementing the scientific concept of development, promoting social harmony and building an overall well-off society, ahead of the Party's once-every-five-year national congress later this year.展开更多
In an attempt to dispel the conspiracy theories and clarify issues for the many detractors that constantly label China’s meteoric development as a threat to the world,Kong Hanbing,professor of international relations...In an attempt to dispel the conspiracy theories and clarify issues for the many detractors that constantly label China’s meteoric development as a threat to the world,Kong Hanbing,professor of international relations at Peking University, recently submitted an article to the Global Times,a Beijing-based publication, in which he said that the players in China’s orchestra may not be always in tune.And that,he said,could be the cause for the uneasiness being felt in the international community.But if China can detect the source of such suspicion and correct its own problems,it will help not only dispel these suspicions,but also benefit its long-term development.Excerpts from the article follow:展开更多
Hope exists for damaged Sino-Japanese relations Japanese Prime Minister Junichiro Koizumi's repeated visits to the war-related Yasukuni Shrine put Sino-Japanese relations in a "politically chilly" situat...Hope exists for damaged Sino-Japanese relations Japanese Prime Minister Junichiro Koizumi's repeated visits to the war-related Yasukuni Shrine put Sino-Japanese relations in a "politically chilly" situation. While many people now have a pessimistic attitude toward relations between the two countries, Fan Yongming, Director of the Japan Research Center of Shanghai-based Fudan University, said in his article published in People's Daily Overseas Edition that there is still hope for a breakthrough in bilater...展开更多
Russian President Dmitry Medvedev seems to remain loyal to Vladimir Putin’s route in his first state of the nation speech will Dmitry Medvedev deviate from predecessor Vladimir Putin’s planned route for Russia? The ...Russian President Dmitry Medvedev seems to remain loyal to Vladimir Putin’s route in his first state of the nation speech will Dmitry Medvedev deviate from predecessor Vladimir Putin’s planned route for Russia? The new Russian president gestured a firm "no" in his first state of the nation speech. Medvedev, who took office in May, delivered the speech at the Federal Assembly on November 5. The speech covered issues ranging from domestic issues to worldwide conflicts, and it indicated that Putin’s policies would carry over to Medvedev’s presidency. Medvedev stressed that Russia should continue political and economic reforms, but he alarmed his international audience with the suggestion that a presidential term be extended to six years from four. In exchange, Medvedev proposed giving the State Duma, the lower house of parliament, stronger check over executive bodies.展开更多
The widespread availability of GPS has opened up a whole new market that provides a plethora of location-based services.Location-based social networks have become very popular as they provide end users like us with se...The widespread availability of GPS has opened up a whole new market that provides a plethora of location-based services.Location-based social networks have become very popular as they provide end users like us with several such services utilizing GPS through our devices.However,when users utilize these services,they inevitably expose personal information such as their ID and sensitive location to the servers.Due to untrustworthy servers and malicious attackers with colossal background knowledge,users'personal information is at risk on these servers.Unfortunately,many privacy-preserving solutions for protecting trajectories have significantly decreased utility after deployment.We have come up with a new trajectory privacy protection solution that contraposes the area of interest for users.Firstly,Staying Points Detection Method based on Temporal-Spatial Restrictions(SPDM-TSR)is an interest area mining method based on temporal-spatial restrictions,which can clearly distinguish between staying and moving points.Additionally,our privacy protection mechanism focuses on the user's areas of interest rather than the entire trajectory.Furthermore,our proposed mechanism does not rely on third-party service providers and the attackers'background knowledge settings.We test our models on real datasets,and the results indicate that our proposed algorithm can provide a high standard privacy guarantee as well as data availability.展开更多
Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of diffe...Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.展开更多
Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key...Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.展开更多
BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data co...BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased morta...BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.展开更多
BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle fact...BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.展开更多
BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as...BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.展开更多
文摘EDITOR'S NOTE:The author wasblessed with a rarechance to be with31 Living Buddhas,kampo abbots andsutra teaches-hail-ing from Tibet andthe areas inhabitedby the Tibetans inSichuan,Qinghai,Gansu and YunnanProvinces,andrecorded the follow-ing stories．
文摘The Double Take column looks at a single topic from an African and Chinese perspective. This month we discuss whether the advent of social media brings relationships closer or moves them farther apart.
文摘The advantage of being a late follower is not forever In 2016 China made $5.5 trillion worth of mobile payments while the United States made $112 billion.China is far ahead of Western countries in
文摘Staying healthy is important,but many people neglect(忽视)their health because they don’t think they have the time to look after it.It’s not just a time matter;people think it’s boring to spend time on their health.In fact,you can do some simple things to get healthier and have fun.There are some fun things that hardly seem like they are for keeping you healthy
基金supported by the officers of the Architecture&Engineering Division,TAISEI Corporation,in facilitating and cooperating with their investigations。
文摘This paper investigates the staying and moving characteristics of office workers in a non-territorial office using an ultra wide band(UWB)impulse radio sensor network.The differences between office workers’staying and moving are clarified according to the individual workstation type that they select.The study determines the characteristics of each type of workstation.By clarifying office workers’preference for staying and moving with regard to individual workstation types and office worker post,the reasons why office workers in different posts tended to select different types of workstations were revealed.Specifically,leaders tended to select workstations at the“inner meeting corner side”most frequently,as they had a greater need to stay in other areas.In contrast,ordinary staff needed to visit office workers in other areas less often,and as such,they tended to select individual workstations at the“middle meeting corner side.”Barring this,they tended to select individual workstations at the“middle corridor side”or“outer-meeting corner side.”Temporary staff members had little need to visit or stay at other places so they tended to select individual workstations at the“window side,”which is seldom visited or stayed at by other office workers and they could be disturbed less often from their solo work.
文摘The annual sessions of the 13th National People's Congress and the 13th National Committee of the Chinese People's Political Consultative Conference, or Two Sessions, that concluded in mid March reflected a general acknowledgement in Beijing that some of the great challenges expected to emerge in the new era have already surfaced, not necessarily sooner than anticipated, but in a difficult combination.
文摘Right in the middle of the deepe ning U.S.-China trade war storm, Huawei Technologies Co.,the world's leading telecom network equipment provider from Chin a, is maki ng world headlines as a result of the U.S. ban on its products and cutoff from its business partners. During an exclusive interview with state broadcaster China Central Television (CCTV) on May 21, Huawei founder and CEO Ren Zhengfei showed little concern about the challenges facing the company.
文摘Hu Jintao, Chinese President and General Secretary of the Communist Party of China (CPC) Central Committee, on June 25 once again stressed the importance of implementing the scientific concept of development, promoting social harmony and building an overall well-off society, ahead of the Party's once-every-five-year national congress later this year.
文摘In an attempt to dispel the conspiracy theories and clarify issues for the many detractors that constantly label China’s meteoric development as a threat to the world,Kong Hanbing,professor of international relations at Peking University, recently submitted an article to the Global Times,a Beijing-based publication, in which he said that the players in China’s orchestra may not be always in tune.And that,he said,could be the cause for the uneasiness being felt in the international community.But if China can detect the source of such suspicion and correct its own problems,it will help not only dispel these suspicions,but also benefit its long-term development.Excerpts from the article follow:
文摘Hope exists for damaged Sino-Japanese relations Japanese Prime Minister Junichiro Koizumi's repeated visits to the war-related Yasukuni Shrine put Sino-Japanese relations in a "politically chilly" situation. While many people now have a pessimistic attitude toward relations between the two countries, Fan Yongming, Director of the Japan Research Center of Shanghai-based Fudan University, said in his article published in People's Daily Overseas Edition that there is still hope for a breakthrough in bilater...
文摘Russian President Dmitry Medvedev seems to remain loyal to Vladimir Putin’s route in his first state of the nation speech will Dmitry Medvedev deviate from predecessor Vladimir Putin’s planned route for Russia? The new Russian president gestured a firm "no" in his first state of the nation speech. Medvedev, who took office in May, delivered the speech at the Federal Assembly on November 5. The speech covered issues ranging from domestic issues to worldwide conflicts, and it indicated that Putin’s policies would carry over to Medvedev’s presidency. Medvedev stressed that Russia should continue political and economic reforms, but he alarmed his international audience with the suggestion that a presidential term be extended to six years from four. In exchange, Medvedev proposed giving the State Duma, the lower house of parliament, stronger check over executive bodies.
文摘The widespread availability of GPS has opened up a whole new market that provides a plethora of location-based services.Location-based social networks have become very popular as they provide end users like us with several such services utilizing GPS through our devices.However,when users utilize these services,they inevitably expose personal information such as their ID and sensitive location to the servers.Due to untrustworthy servers and malicious attackers with colossal background knowledge,users'personal information is at risk on these servers.Unfortunately,many privacy-preserving solutions for protecting trajectories have significantly decreased utility after deployment.We have come up with a new trajectory privacy protection solution that contraposes the area of interest for users.Firstly,Staying Points Detection Method based on Temporal-Spatial Restrictions(SPDM-TSR)is an interest area mining method based on temporal-spatial restrictions,which can clearly distinguish between staying and moving points.Additionally,our privacy protection mechanism focuses on the user's areas of interest rather than the entire trajectory.Furthermore,our proposed mechanism does not rely on third-party service providers and the attackers'background knowledge settings.We test our models on real datasets,and the results indicate that our proposed algorithm can provide a high standard privacy guarantee as well as data availability.
文摘Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.
文摘Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.
基金supported by the National Natural Science Foundation of China(82230074,81971809 and 82372159)the Liangshan Prefecture Science and Technology Plan Project(23ZDYF0180 and 24YYYJ0043).
文摘BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.
基金Supported by Shandong Province Biliary Pancreatic Cancer Clinical Quality Specialty Construction Fund,No.SLCZDZK-2401.
文摘BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.
文摘BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.
