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
Against the backdrop of the strategies for rural revitalization and the integration of agriculture,culture,and tourism,farm stay,as a vital carrier,requires a systematic analysis of its resource integration effectiven...Against the backdrop of the strategies for rural revitalization and the integration of agriculture,culture,and tourism,farm stay,as a vital carrier,requires a systematic analysis of its resource integration effectiveness and the actual needs of tourists.Taking Chongqing City as an example,this study leverages tourist reviews from the Dianping platform(China’s leading consumer review site)and employs a combination of TF-IDF keyword extraction,SnowNLP sentiment analysis,and LDA topic modeling to dissect tourists’perception characteristics and latent demands for agritourism resources from the demand side.The findings reveal that agricultural and tourism elements garner significant attention,while cultural resources are notably underperceived,indicating an imbalanced integration structure.Sentiment is predominantly positive,yet negative feedback highlights issues in service management,transportation,and homogenized experiences.Latent demands converge on three dimensions:deepening agricultural experiences,enhancing cultural participation and interaction,and improving environmental and service quality.Based on these findings,this study proposes integration enhancement strategies,including agricultural branding,cultural vitalization,service intelligence,and multi-faceted collaboration,to drive experience upgrades and sustainable development in farm stays,offering theoretical references and practical pathways for rural tourism integration in similar regions.展开更多
Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardia...Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardiac surgery with CPB and identify associated risk factors.Methods:The current investigation was an observational,retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017.Data were obtained from the hospital database.Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.Results:Of 395 patients,137(34.7%)had a prolonged ICU LOS(>72.0 h),and the median ICU LOS was 50.9 h.Several variables were found associated with prolonged ICU LOS:duration of CPB,prolonged mechanical ventilation and non-invasive assisted ventilation use,PaO2/FiO2 ratios within 6 h after surgery,type of surgery,red blood cell infusion during surgery,postoperative atrial arrhythmia,postoperative ventricular arrhythmia(all P<0.05).Conclusions:These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS,enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.展开更多
The needs of patients who can stay for extended periods in hospitals generate large amounts of health care expenses. They usually experience multiple diagnoses and their needs are not easily understood or served. This...The needs of patients who can stay for extended periods in hospitals generate large amounts of health care expenses. They usually experience multiple diagnoses and their needs are not easily understood or served. This study described the efforts of the acute hospitals in Syracuse, New York to address the needs of these Complex Care patients. The hospitals developed a series of Subacute Programs, each of which addressed a single care need, which might have helped restrain the growth of adult medicine stays during a five-month period. The study demonstrated that reductions in adult medicine stays were associated with the introduction of Complex Care Programs that addressed multiple care needs, in 2015. The association between the implementation of the Complex Care Programs and length of stay reduction for adult medicine was present at the combined and individual hospital levels. The study suggested that the amount of Program Development Funds invested in these programs saved 2000 adult medicine days or $1,600,000 compared with total expenses of $292,000 during a five-month period. The experiences of the Syracuse hospitals suggested that small programs with simple structures could have a positive impact on health care efficiency at the community level.展开更多
This study described a series of programs implemented in Syracuse, New York to support the movement of long term acute care patients to skilled nursing facilities. The Difficult to Place Program involved the identific...This study described a series of programs implemented in Syracuse, New York to support the movement of long term acute care patients to skilled nursing facilities. The Difficult to Place Program involved the identification of these patients and the communication of information concerning them between hospitals and nursing homes on a continuing basis. These patients involved approximately 20 percent of new admissions to nursing homes. The Subacute Programs included services such as intravenous therapy and offsite transportation that were not originally available in area nursing homes. The Subacute Program stimulated the development of these services in long term care. The Complex Care Programs have included services for patients with high severity of illness such as multiple intravenous antibiotic therapy and high cost medications. The Subacute and Complex Care Programs included 5 - 6 percent of Difficult to Place patients. The study demonstrated that these programs reduced the number of annual adult medicine and adult surgery patient days by 2288 between 2011 and 2017.展开更多
Background:Low relative sit-to-stand(STS)power has emerged as a critical predictor of adverse health outcomes,such as frailty and disability,in older adults.However,its impact on falls,fractures,hospitalizations,and a...Background:Low relative sit-to-stand(STS)power has emerged as a critical predictor of adverse health outcomes,such as frailty and disability,in older adults.However,its impact on falls,fractures,hospitalizations,and all-cause mortality remains unclear.Therefore,this longitudinal study aimed to investigate the potential associations between low relative STS power and these adverse health outcomes in older adults.Methods:A total of 1876 older adults(aged≥65 years,56.4%women)were included from the Toledo Study for Healthy Aging.Relative STS power was assessed using the 30-s STS test and the Alcazar equation.Participants were categorized as having low relative STS power based on previously established cut-off points(2.53 W/kg for men and 2.01 W/kg for women).Falls and fractures(hip and all-type)within the previous year were recorded.Hospitalizations and all-cause mortality were obtained during a follow-up of 6.8±3.1 years(mean±SD;median=7.8 years;interquartile range:3.9-10.1 years)and 9.7±3.5 years(median=10.9 years;interquartile range:8.2-12.5 years),respectively.Generalized linear mixed models,binary logistic regression,and proportional hazards regression adjusted for age,educational level,and comorbidities were used.Results:In men,low relative STS power was significantly associated with an increased likelihood of history of falls(odds ratio(OR)=1.73,95%confidence interval(95%CI):1.08-2.75,p=0.022)and all-type fractures(OR=1.86,95%CI:1.21-2.84,p=0.004)in the previous year.In women,low relative STS power was associated with a higher probability of hip fractures within the previous year(OR=3.25,95%CI:1.07-9.86,p=0.038).Low relative STS power predicted hospitalizations in women(hazard ratio(HR)=1.29,95%CI:1.06-1.58,p=0.012)and longer hospital stays in both men(p=0.020)and women(p=0.033).Low relative STS power significantly increased all-cause mortality in both men(HR=1.57,95%CI:1.26-1.97,p<0.001)and women(HR=2.04,95%CI:1.51-2.74,p<0.001).Conclusion:Low relative STS power was associated with history of hip fractures in women,whereas in men it was associated with history of falls and all-type fractures.Low relative STS power predicted hospitalizations in women but not in men.In both men and women,low relative STS power was associated with longer hospital stays and increased risk of all-cause mortality.展开更多
Many people have bad habits,and they are not good for you.Bad habits can be staying up too late,eating too many sweets or biting your nails.Bad habits aren't easy to break,but you can do it!First,notice when you d...Many people have bad habits,and they are not good for you.Bad habits can be staying up too late,eating too many sweets or biting your nails.Bad habits aren't easy to break,but you can do it!First,notice when you do the habit.Then,try to do something else,such as chewing gum or reading a book.Ask a friend to help you stop.They can watch you and remind you.Do your best and don't stop trying.Changing little by little can make a difference!展开更多
As cobalt stayed at high price,net profits of 4major cobalt producers in China realizedsignificant growth in H1 of 2018.According to the semiannual report publishedon the evening of August 28,2018 by HanruiCobalt。
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 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
BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensiv...BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensive,safe,and ready-touse oral solution that can supplement sodium in such cases.AIM To assess the impact of prophylactic sodium supplementation via ORS on clinical and hospital outcomes in infants and children admitted with pneumonia.METHODS A randomized,interventional controlled trial was conducted on 140 infants and children admitted with pneumonia(70 per group).The primary outcome was hospital length of stay,with secondary outcomes including serum sodium and potassium levels,clinical respiratory scores,modified shock index,and nutritional/inflammatory markers.The hospital length of stay and both the laboratory and clinical parameters of the interventional and control groups were compared.RESULTS The hospital stay was longer in the control group than in the intervention group(P value=0.001;effect size=0.59).Clinical respiratory scores on day 4 were significantly lower in the intervention group than in the control group(P value=0.001).Sodium levels were significantly lower in the control group than in the intervention group at discharge(P value=0.002).CONCLUSION Prophylactic oral sodium supplementation through ORS may have a health-promoting effect on infants and children admitted with pneumonia.展开更多
BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive system that poses a serious threat to human health.During the perioperative period,patients with CRC are prone to nutritional risks and mal...BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive system that poses a serious threat to human health.During the perioperative period,patients with CRC are prone to nutritional risks and malnutrition.Compared with traditional nutritional support,immunostimulatory nutrients,including glutamine(Gln),have attracted increasing attention.Although many previous studies have reported that perioperative Gln supplementation can improve short-term clinical outcomes in patients with CRC,some studies have not demonstrated a benefit.Resolution of Gln supplementation value thus requires further exploration.AIM To clarify the influence of perioperative Gln-enhanced nutritional support on postoperative outcomes including nutritional status,immune function,inflammation levels,morbidity due to complications,and length of hospital stay(LOS).METHODS A comprehensive literature search was conducted(inception to June 2025).PubMed,EMBASE,Web of Science,Cochrane Library,China Biomedical Database,CNKI,VIP,and the Wanfang Electronic Database were searched.This meta-analysis ultimately included 27 studies with a total of 1643 patients;827 patients received perioperative Gln treatment and 816 received conventional nutritional therapy.A random-effects model was used to pool relative risks(RR)and mean differences(MD)with 95%confidence intervals(CI).RESULTS Pooled analysis showed that Gln intervention reduced morbidity associated with postoperative infectious complications(RR=0.36;95%CI:0.24-0.54)and non-infectious complications(RR=0.32;95%CI:0.19-0.55)and shortened the LOS by 2.31 days(MD=-2.31;95%CI:-3.21 to-1.41)in CRC patients.Gln supplementation also increased serum albumin,prealbumin,peripheral blood lymphocyte count,and nitrogen balance levels and improved humoral and cellular immune function.We also found that postoperative tumor necrosis factor-αand C-reactive protein levels were lower in Gln-supplemented patients.By contrast,Gln supplementation did not improve CD8+and CD4+/CD8+levels.CONCLUSION Gln supplementation effectively improved short-term clinical outcomes in patients with CRC.展开更多
BACKGROUND External gastrointestinal fistulas(EGIFs)are serious postoperative complications associated with prolonged hospital stays,sepsis,malnutrition,and high mortality rates.Reducing gastrointestinal secretions wi...BACKGROUND External gastrointestinal fistulas(EGIFs)are serious postoperative complications associated with prolonged hospital stays,sepsis,malnutrition,and high mortality rates.Reducing gastrointestinal secretions with somatostatin or its analogues may facilitate fistula closure.The clinical effectiveness of these therapies,however,remains uncertain.AIM To investigate the effectiveness of somatostatin-based therapy for EGIFs.METHODS A systematic review and meta-analysis(Prospero CRD420251054344)of nine randomized controlled trials(442 patients)compared somatostatin-based therapies with standard care in tertiary care settings.Protocols included somatostatin,octreotide,or lanreotide,administered at various dosages(250 micrograms/hour intravenous infusion or 100 micrograms subcutaneous injection three times daily)for 7 to 56 days.Primary outcomes were fistula closure rates and time to closure.Secondary outcomes were hospital length of stay,complications,need for surgical intervention,and mortality.Mean differences and risk ratios(RRs)with 95%confidence intervals(CIs)were calculated using random-effects models.Risk of bias was assessed with the Cochrane RoB 2 tool.RESULTS There was no statistically significant difference in closure rate(RR:1.11,95%CI:0.95-1.28,P=0.19,I^(2)=0%)between 134/193 patients receiving somatostatin-based therapy and 99/170 control patients.Time to closure was reduced by 6.16 days(mean difference-6.16,95%CI:-7.44 to-4.88,P<0.001,I^(2)=0%)in 126 patients in intervention group vs 114 in control group.Hospital stay was shortened by 4.00 days(mean difference-4.00,95%CI:-7.99 to-0.01,P=0.05,I^(2)=0%)in 56 vs 62 patients.There were no differences in complications(RRs:0.76,95%CI:0.55-1.05),need for surgical intervention(RRs:0.67,95%CI:0.38-1.19),or mortality(RRs:0.77,95%CI:0.44-1.35).Limitations include small sample sizes,heterogeneity in treatment regimens,and inconsistent outcome definitions,which may affect generalizability.Limited data for some outcomes,such as hospital stay,and exclusion of some datasets for methodological reasons reduced statistical power.CONCLUSION Somatostatin-based therapies did not significantly improve fistula closure rates but were associated with shorter time to closure and hospital stay.Mortality,complications,and surgical intervention requirements remained unchanged,suggesting that these therapies may serve only as an adjunctive option in selected patients.展开更多
BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of A...BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample database.Adult patients with AF who underwent an inpatient ERCP were identified,then stratified by timing of ERCP,via international classification of diseases-10 codes.The primary outcome was all-cause in-hospital mortality.Secondary outcomes,including resource utilization,were assessed.Statistical analysis was performed using STATA software.RESULTS Of the 433245 patients that underwent an ERCP,49615 had a diagnosis of AF.Patients with AF had a significantly higher in-hospital mortality compared to those without AF[3.82%vs 1.13%,odds ratio(OR)=1.93,P<0.01].AF was significantly associated with increased hospital stay(+1.71 days),hospital charges($21210),shock(OR=2.17),sepsis(OR=1.34),intensive care unit admission(OR=2.41),acute kidney injury(OR=1.51),as well as a decreased likelihood of discharge to home(OR=0.59),(all with P<0.01).These results were consistent after propensity score matching.Upon subgroup analysis,patients with AF,whom underwent ERCP>72 hours,had worse outcomes including higher inhospital mortality(adjusted OR=1.47,P<0.01).CONCLUSION By way of this large,national analysis it appears AF is associated with significantly worse hospitalization outcomes,inducing increased mortality,in those undergoing ERCP.Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.展开更多
BACKGROUND The clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial,particularly under the enhanced recovery after surgery(ERAS)protocol.ERAS advocates a multimodal peri...BACKGROUND The clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial,particularly under the enhanced recovery after surgery(ERAS)protocol.ERAS advocates a multimodal perioperative strategy designed to attenuate surgical stress and optimize postoperative convalescence.AIM To evaluate the necessity of abdominal drainage tube placement following radical gastrectomy in the context of ERAS protocols.METHODS A systematic review and meta-analysis were conducted by searching PubMed,EMBASE,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang,VIP Information,and SinoMed databases for randomized controlled trials comparing outcomes of abdominal drainage vs no drainage after gastrectomy under ERAS protocols.Primary outcomes included time to gastrointestinal function recovery,drainage tube removal time,postoperative complication rates,and length of hospital stay.Review Manager 5.4 was used for statistical analysis,and heterogeneity was assessed using the I2 statistic.RESULTS A total of 21 randomized controlled trials involving 1652 patients were included.Compared with routine abdominal drainage,the ERAS group without drainage showed significantly faster gastrointestinal recovery[standardized mean difference=-1.30,95%confidence interval(CI):-1.66 to-0.94,P<0.00001]and shorter hospital stay(standardized mean difference=-1.37,95%CI:-1.86 to-0.88,P<0.00001).The incidence of total postoperative complications was also significantly lower(odds ratio=0.53,95%CI:0.40-0.70,P<0.00001),particularly for anastomotic leakage and pulmonary infection.No significant differences were observed in surgical site infections or urinary tract infections.Sensitivity and subgroup analyses indicated stability of results,although some heterogeneity was noted.CONCLUSION Avoiding routine abdominal drainage under ERAS could lead to faster recovery,reduced complications,and shorter hospital stay following radical gastrectomy,supporting the selective use of drainage rather than routine.展开更多
BACKGROUND Intensive care units(ICUs)are stressful milieus for patients,particularly when under mechanical ventilation.Music is a non-pharmacological intervention that has shown a positive impact on physiological and ...BACKGROUND Intensive care units(ICUs)are stressful milieus for patients,particularly when under mechanical ventilation.Music is a non-pharmacological intervention that has shown a positive impact on physiological and psychological parameters in patients on mechanical ventilation.AIM To evaluate outcome of music therapy on patients who are critically ill to note the effect on ICU stays.METHODS One-hundred-and-thirty-six adult patients with acute respiratory failure requiring mechanical ventilation for 48 hours or more were randomized into the music therapy or routine care(control)groups.Patients were assessed for weaning criteria before music therapy was given.If eligible,a 30-minute music therapy was given prior to the extubation.Vital parameters were recorded at 5-minute intervals of therapy.Visual Analog Scale(VAS)-Dyspnea and VAS-Anxiety(VASA)were assessed before and after therapy.Richmond Agitation-Sedation Scale and Numerical Rating Scale scoring were conducted.RESULTS The difference in times of ventilator support in the music therapy intervention group(58.22±14.90 hours)and the control group(56.88±13.10 hours)was not statistically significant.ICU length of stay was significantly lower in the music therapy group(4.97±1.70 days vs control group:5.70±1.74 days).ICU mortality was significantly lower in the music therapy group as compared with the control group(7.4%vs 19.1%;P=0.043).At 0 minute the VAS-A scores of the music therapy(6.82±1.36)and control group(7.07±1.07)were comparable.During the remainder of the observation period,the VAS score of the music therapy group was significantly lower than that of the control group.CONCLUSION Music therapy is an inexpensive non-pharmacological intervention for patients in the ICU.However,future multicenter studies are warranted before routinely using music therapy in patients in the ICU.展开更多
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.
基金Chongqing University of Science and Technology Graduate Innovation Program Project(YKJCX2420802)。
文摘Against the backdrop of the strategies for rural revitalization and the integration of agriculture,culture,and tourism,farm stay,as a vital carrier,requires a systematic analysis of its resource integration effectiveness and the actual needs of tourists.Taking Chongqing City as an example,this study leverages tourist reviews from the Dianping platform(China’s leading consumer review site)and employs a combination of TF-IDF keyword extraction,SnowNLP sentiment analysis,and LDA topic modeling to dissect tourists’perception characteristics and latent demands for agritourism resources from the demand side.The findings reveal that agricultural and tourism elements garner significant attention,while cultural resources are notably underperceived,indicating an imbalanced integration structure.Sentiment is predominantly positive,yet negative feedback highlights issues in service management,transportation,and homogenized experiences.Latent demands converge on three dimensions:deepening agricultural experiences,enhancing cultural participation and interaction,and improving environmental and service quality.Based on these findings,this study proposes integration enhancement strategies,including agricultural branding,cultural vitalization,service intelligence,and multi-faceted collaboration,to drive experience upgrades and sustainable development in farm stays,offering theoretical references and practical pathways for rural tourism integration in similar regions.
基金This work was supported by the Science and Technology Planning Project of Guangdong Province,China[grant numbers 20160910].
文摘Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardiac surgery with CPB and identify associated risk factors.Methods:The current investigation was an observational,retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017.Data were obtained from the hospital database.Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.Results:Of 395 patients,137(34.7%)had a prolonged ICU LOS(>72.0 h),and the median ICU LOS was 50.9 h.Several variables were found associated with prolonged ICU LOS:duration of CPB,prolonged mechanical ventilation and non-invasive assisted ventilation use,PaO2/FiO2 ratios within 6 h after surgery,type of surgery,red blood cell infusion during surgery,postoperative atrial arrhythmia,postoperative ventricular arrhythmia(all P<0.05).Conclusions:These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS,enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.
文摘The needs of patients who can stay for extended periods in hospitals generate large amounts of health care expenses. They usually experience multiple diagnoses and their needs are not easily understood or served. This study described the efforts of the acute hospitals in Syracuse, New York to address the needs of these Complex Care patients. The hospitals developed a series of Subacute Programs, each of which addressed a single care need, which might have helped restrain the growth of adult medicine stays during a five-month period. The study demonstrated that reductions in adult medicine stays were associated with the introduction of Complex Care Programs that addressed multiple care needs, in 2015. The association between the implementation of the Complex Care Programs and length of stay reduction for adult medicine was present at the combined and individual hospital levels. The study suggested that the amount of Program Development Funds invested in these programs saved 2000 adult medicine days or $1,600,000 compared with total expenses of $292,000 during a five-month period. The experiences of the Syracuse hospitals suggested that small programs with simple structures could have a positive impact on health care efficiency at the community level.
文摘This study described a series of programs implemented in Syracuse, New York to support the movement of long term acute care patients to skilled nursing facilities. The Difficult to Place Program involved the identification of these patients and the communication of information concerning them between hospitals and nursing homes on a continuing basis. These patients involved approximately 20 percent of new admissions to nursing homes. The Subacute Programs included services such as intravenous therapy and offsite transportation that were not originally available in area nursing homes. The Subacute Program stimulated the development of these services in long term care. The Complex Care Programs have included services for patients with high severity of illness such as multiple intravenous antibiotic therapy and high cost medications. The Subacute and Complex Care Programs included 5 - 6 percent of Difficult to Place patients. The study demonstrated that these programs reduced the number of annual adult medicine and adult surgery patient days by 2288 between 2011 and 2017.
基金supported by Centro de Investigaci on Biom edica en Red Fragilidad y Envejecimiento Saludable(CIBERFES)(Grant Nos.CB16/10/00477,CB16/10/00456,and CB16/10/00464)Plan Propio de Investigaci on of the University of Castilla-La Mancha,and Fondo Europeo de Desarrollo Regional(FEDER)funds from the European Union(Grant No.2022-GRIN-34296)+3 种基金further funded by grants from the Instituto de Salud Carlos III(Grant Nos.PI031558,PI07/90637,PI07/90306,RD 06/0013,and PI18/00972)the Government of Castilla-La Mancha(Grant Nos.03031 and SBPLY/19/180501/000312)Red EXERNETRED DE EJERCICIO FISICO Y SALUD:RED2022-134800T from the Spanish Ministry of Innovation and Sciencesupported by a research grant from the University of Castilla-La Mancha(Programa Investigo,Grant No.2024INVGO-12359)。
文摘Background:Low relative sit-to-stand(STS)power has emerged as a critical predictor of adverse health outcomes,such as frailty and disability,in older adults.However,its impact on falls,fractures,hospitalizations,and all-cause mortality remains unclear.Therefore,this longitudinal study aimed to investigate the potential associations between low relative STS power and these adverse health outcomes in older adults.Methods:A total of 1876 older adults(aged≥65 years,56.4%women)were included from the Toledo Study for Healthy Aging.Relative STS power was assessed using the 30-s STS test and the Alcazar equation.Participants were categorized as having low relative STS power based on previously established cut-off points(2.53 W/kg for men and 2.01 W/kg for women).Falls and fractures(hip and all-type)within the previous year were recorded.Hospitalizations and all-cause mortality were obtained during a follow-up of 6.8±3.1 years(mean±SD;median=7.8 years;interquartile range:3.9-10.1 years)and 9.7±3.5 years(median=10.9 years;interquartile range:8.2-12.5 years),respectively.Generalized linear mixed models,binary logistic regression,and proportional hazards regression adjusted for age,educational level,and comorbidities were used.Results:In men,low relative STS power was significantly associated with an increased likelihood of history of falls(odds ratio(OR)=1.73,95%confidence interval(95%CI):1.08-2.75,p=0.022)and all-type fractures(OR=1.86,95%CI:1.21-2.84,p=0.004)in the previous year.In women,low relative STS power was associated with a higher probability of hip fractures within the previous year(OR=3.25,95%CI:1.07-9.86,p=0.038).Low relative STS power predicted hospitalizations in women(hazard ratio(HR)=1.29,95%CI:1.06-1.58,p=0.012)and longer hospital stays in both men(p=0.020)and women(p=0.033).Low relative STS power significantly increased all-cause mortality in both men(HR=1.57,95%CI:1.26-1.97,p<0.001)and women(HR=2.04,95%CI:1.51-2.74,p<0.001).Conclusion:Low relative STS power was associated with history of hip fractures in women,whereas in men it was associated with history of falls and all-type fractures.Low relative STS power predicted hospitalizations in women but not in men.In both men and women,low relative STS power was associated with longer hospital stays and increased risk of all-cause mortality.
文摘Many people have bad habits,and they are not good for you.Bad habits can be staying up too late,eating too many sweets or biting your nails.Bad habits aren't easy to break,but you can do it!First,notice when you do the habit.Then,try to do something else,such as chewing gum or reading a book.Ask a friend to help you stop.They can watch you and remind you.Do your best and don't stop trying.Changing little by little can make a difference!
文摘As cobalt stayed at high price,net profits of 4major cobalt producers in China realizedsignificant growth in H1 of 2018.According to the semiannual report publishedon the evening of August 28,2018 by HanruiCobalt。
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.
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.
文摘BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensive,safe,and ready-touse oral solution that can supplement sodium in such cases.AIM To assess the impact of prophylactic sodium supplementation via ORS on clinical and hospital outcomes in infants and children admitted with pneumonia.METHODS A randomized,interventional controlled trial was conducted on 140 infants and children admitted with pneumonia(70 per group).The primary outcome was hospital length of stay,with secondary outcomes including serum sodium and potassium levels,clinical respiratory scores,modified shock index,and nutritional/inflammatory markers.The hospital length of stay and both the laboratory and clinical parameters of the interventional and control groups were compared.RESULTS The hospital stay was longer in the control group than in the intervention group(P value=0.001;effect size=0.59).Clinical respiratory scores on day 4 were significantly lower in the intervention group than in the control group(P value=0.001).Sodium levels were significantly lower in the control group than in the intervention group at discharge(P value=0.002).CONCLUSION Prophylactic oral sodium supplementation through ORS may have a health-promoting effect on infants and children admitted with pneumonia.
基金Supported by National Natural Science Foundation of China,No.81960105Medical Research Union Fund for High-quality Health Development of Guizhou Province,No.2024GZYXKYJJXM0155.
文摘BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive system that poses a serious threat to human health.During the perioperative period,patients with CRC are prone to nutritional risks and malnutrition.Compared with traditional nutritional support,immunostimulatory nutrients,including glutamine(Gln),have attracted increasing attention.Although many previous studies have reported that perioperative Gln supplementation can improve short-term clinical outcomes in patients with CRC,some studies have not demonstrated a benefit.Resolution of Gln supplementation value thus requires further exploration.AIM To clarify the influence of perioperative Gln-enhanced nutritional support on postoperative outcomes including nutritional status,immune function,inflammation levels,morbidity due to complications,and length of hospital stay(LOS).METHODS A comprehensive literature search was conducted(inception to June 2025).PubMed,EMBASE,Web of Science,Cochrane Library,China Biomedical Database,CNKI,VIP,and the Wanfang Electronic Database were searched.This meta-analysis ultimately included 27 studies with a total of 1643 patients;827 patients received perioperative Gln treatment and 816 received conventional nutritional therapy.A random-effects model was used to pool relative risks(RR)and mean differences(MD)with 95%confidence intervals(CI).RESULTS Pooled analysis showed that Gln intervention reduced morbidity associated with postoperative infectious complications(RR=0.36;95%CI:0.24-0.54)and non-infectious complications(RR=0.32;95%CI:0.19-0.55)and shortened the LOS by 2.31 days(MD=-2.31;95%CI:-3.21 to-1.41)in CRC patients.Gln supplementation also increased serum albumin,prealbumin,peripheral blood lymphocyte count,and nitrogen balance levels and improved humoral and cellular immune function.We also found that postoperative tumor necrosis factor-αand C-reactive protein levels were lower in Gln-supplemented patients.By contrast,Gln supplementation did not improve CD8+and CD4+/CD8+levels.CONCLUSION Gln supplementation effectively improved short-term clinical outcomes in patients with CRC.
文摘BACKGROUND External gastrointestinal fistulas(EGIFs)are serious postoperative complications associated with prolonged hospital stays,sepsis,malnutrition,and high mortality rates.Reducing gastrointestinal secretions with somatostatin or its analogues may facilitate fistula closure.The clinical effectiveness of these therapies,however,remains uncertain.AIM To investigate the effectiveness of somatostatin-based therapy for EGIFs.METHODS A systematic review and meta-analysis(Prospero CRD420251054344)of nine randomized controlled trials(442 patients)compared somatostatin-based therapies with standard care in tertiary care settings.Protocols included somatostatin,octreotide,or lanreotide,administered at various dosages(250 micrograms/hour intravenous infusion or 100 micrograms subcutaneous injection three times daily)for 7 to 56 days.Primary outcomes were fistula closure rates and time to closure.Secondary outcomes were hospital length of stay,complications,need for surgical intervention,and mortality.Mean differences and risk ratios(RRs)with 95%confidence intervals(CIs)were calculated using random-effects models.Risk of bias was assessed with the Cochrane RoB 2 tool.RESULTS There was no statistically significant difference in closure rate(RR:1.11,95%CI:0.95-1.28,P=0.19,I^(2)=0%)between 134/193 patients receiving somatostatin-based therapy and 99/170 control patients.Time to closure was reduced by 6.16 days(mean difference-6.16,95%CI:-7.44 to-4.88,P<0.001,I^(2)=0%)in 126 patients in intervention group vs 114 in control group.Hospital stay was shortened by 4.00 days(mean difference-4.00,95%CI:-7.99 to-0.01,P=0.05,I^(2)=0%)in 56 vs 62 patients.There were no differences in complications(RRs:0.76,95%CI:0.55-1.05),need for surgical intervention(RRs:0.67,95%CI:0.38-1.19),or mortality(RRs:0.77,95%CI:0.44-1.35).Limitations include small sample sizes,heterogeneity in treatment regimens,and inconsistent outcome definitions,which may affect generalizability.Limited data for some outcomes,such as hospital stay,and exclusion of some datasets for methodological reasons reduced statistical power.CONCLUSION Somatostatin-based therapies did not significantly improve fistula closure rates but were associated with shorter time to closure and hospital stay.Mortality,complications,and surgical intervention requirements remained unchanged,suggesting that these therapies may serve only as an adjunctive option in selected patients.
文摘BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample database.Adult patients with AF who underwent an inpatient ERCP were identified,then stratified by timing of ERCP,via international classification of diseases-10 codes.The primary outcome was all-cause in-hospital mortality.Secondary outcomes,including resource utilization,were assessed.Statistical analysis was performed using STATA software.RESULTS Of the 433245 patients that underwent an ERCP,49615 had a diagnosis of AF.Patients with AF had a significantly higher in-hospital mortality compared to those without AF[3.82%vs 1.13%,odds ratio(OR)=1.93,P<0.01].AF was significantly associated with increased hospital stay(+1.71 days),hospital charges($21210),shock(OR=2.17),sepsis(OR=1.34),intensive care unit admission(OR=2.41),acute kidney injury(OR=1.51),as well as a decreased likelihood of discharge to home(OR=0.59),(all with P<0.01).These results were consistent after propensity score matching.Upon subgroup analysis,patients with AF,whom underwent ERCP>72 hours,had worse outcomes including higher inhospital mortality(adjusted OR=1.47,P<0.01).CONCLUSION By way of this large,national analysis it appears AF is associated with significantly worse hospitalization outcomes,inducing increased mortality,in those undergoing ERCP.Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.
文摘BACKGROUND The clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial,particularly under the enhanced recovery after surgery(ERAS)protocol.ERAS advocates a multimodal perioperative strategy designed to attenuate surgical stress and optimize postoperative convalescence.AIM To evaluate the necessity of abdominal drainage tube placement following radical gastrectomy in the context of ERAS protocols.METHODS A systematic review and meta-analysis were conducted by searching PubMed,EMBASE,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang,VIP Information,and SinoMed databases for randomized controlled trials comparing outcomes of abdominal drainage vs no drainage after gastrectomy under ERAS protocols.Primary outcomes included time to gastrointestinal function recovery,drainage tube removal time,postoperative complication rates,and length of hospital stay.Review Manager 5.4 was used for statistical analysis,and heterogeneity was assessed using the I2 statistic.RESULTS A total of 21 randomized controlled trials involving 1652 patients were included.Compared with routine abdominal drainage,the ERAS group without drainage showed significantly faster gastrointestinal recovery[standardized mean difference=-1.30,95%confidence interval(CI):-1.66 to-0.94,P<0.00001]and shorter hospital stay(standardized mean difference=-1.37,95%CI:-1.86 to-0.88,P<0.00001).The incidence of total postoperative complications was also significantly lower(odds ratio=0.53,95%CI:0.40-0.70,P<0.00001),particularly for anastomotic leakage and pulmonary infection.No significant differences were observed in surgical site infections or urinary tract infections.Sensitivity and subgroup analyses indicated stability of results,although some heterogeneity was noted.CONCLUSION Avoiding routine abdominal drainage under ERAS could lead to faster recovery,reduced complications,and shorter hospital stay following radical gastrectomy,supporting the selective use of drainage rather than routine.
文摘BACKGROUND Intensive care units(ICUs)are stressful milieus for patients,particularly when under mechanical ventilation.Music is a non-pharmacological intervention that has shown a positive impact on physiological and psychological parameters in patients on mechanical ventilation.AIM To evaluate outcome of music therapy on patients who are critically ill to note the effect on ICU stays.METHODS One-hundred-and-thirty-six adult patients with acute respiratory failure requiring mechanical ventilation for 48 hours or more were randomized into the music therapy or routine care(control)groups.Patients were assessed for weaning criteria before music therapy was given.If eligible,a 30-minute music therapy was given prior to the extubation.Vital parameters were recorded at 5-minute intervals of therapy.Visual Analog Scale(VAS)-Dyspnea and VAS-Anxiety(VASA)were assessed before and after therapy.Richmond Agitation-Sedation Scale and Numerical Rating Scale scoring were conducted.RESULTS The difference in times of ventilator support in the music therapy intervention group(58.22±14.90 hours)and the control group(56.88±13.10 hours)was not statistically significant.ICU length of stay was significantly lower in the music therapy group(4.97±1.70 days vs control group:5.70±1.74 days).ICU mortality was significantly lower in the music therapy group as compared with the control group(7.4%vs 19.1%;P=0.043).At 0 minute the VAS-A scores of the music therapy(6.82±1.36)and control group(7.07±1.07)were comparable.During the remainder of the observation period,the VAS score of the music therapy group was significantly lower than that of the control group.CONCLUSION Music therapy is an inexpensive non-pharmacological intervention for patients in the ICU.However,future multicenter studies are warranted before routinely using music therapy in patients in the ICU.
