To analyze the risk factors for postoperative hypoxemia in Stanford type A aortic dissection (TAAD), construct a risk nomogram model based on risk factors, and validate its efficacy.

A retrospective analysis was conducted on 347 TAAD patients treated in Ningbo Medical Center Lihuili Hospital from February 2019 to May 2025. The patients were divided into a training set of 260 cases and a validation set of 87 cases in a 3∶1 ratio. In the training set, there were 128 males and 132 females, with ages ranging from 22 to 81 years [(51.73±15.93) years]. The hypoxemia group and non hypoxemia group were analyzed based on whether hypoxemia occurred 24 hours after surgery. The clinical data of the two groups were compared, and binary logistic regression was used to analyze the risk factors for postoperative hypoxemia in TAAD patients. A nomogram prediction model was constructed based on risk factors. The predictive value of the model was analyzed using receiver operating characteristic (ROC) curves, and the model calibration was evaluated using Hosmer-Lemeshow goodness of fit test.

The proportions of patients aged ≥50 years, body mass index (BMI) ≥25 kg/m², pericardial effusion, white blood cell (WBC) count, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and blood ransfusion volume were higher in the hypoxemia group than in the non-hypoxemia group; the cardiopulmonary bypass time was longer in the hypoxemia group (P<0.05). According to binary logistic regression analysis, age≥50 years old, BMI≥25 kg/m², pericardial effusion, high WBC count, high hs-CRP, and prolonged cardiopulmonary bypass are risk factors for postoperative hypoxemia in TAAD patients (P<0.05). The constructed nomogram model has a C-index of 0.863 (95%CI: 0.818-0.909) on the training set and 0.856 after Bootstrap correction, with a difference of only 0.007, indicating a low risk of overfitting; The accuracy of the model is 78%. The C-index of the validation set is 0.842 (95%CI: 0.759-0.942), which is close to the corrected value, indicating good generalization ability of the model.

The predictive model for postoperative hypoxemia in TAAD patients constructed in this article shows good performance and can provide auxiliary predictive value for the occurrence of postoperative hypoxemia in TAAD patients.

To explore the early diagnostic value of soluble growth stimulation expressed gene 2 (sST2) and cardiac troponin I (cTnI) combined with bedside echocardiography for sepsis-induced myocardial depression.

100 sepsis patients admitted to Xiaogan Central Hospital from January 2022 to December 2024 were selected as the research subjects, including 59 males and 41 females, aged 32-70 years [(53.59±4.18) years]. According to the occurrence of myocardial depression, they were divided into a myocardial depression group [(LVEF≤50%) (n=34)] and a non-myocardial depression group [(LVEF>50%) (n=66)]. According to the final prognosis, they were divided into a survival group (n=88) and death group (n=12). All patients underwent serum sST2, cTnI levels measurement and bedside echocardiography examination to analyze the changes in serum sST2, cTnI levels and bedside echocardiography [left ventricular posterior wall thickness in diastole (LVPWd), left ventricular posterior wall thickness in systole (LVPWs)], and to analyze their early diagnostic value using receiver operating characteristic (ROC) curves.

Serum levels of sST2 and cTnI in the myocardial inhibition group were significantly higher than those in the non-myocardial inhibition group (P<0.05); LVPWd and LVPWs levels in the myocardial depression group were significantly higher than those in the non-myocardial depression group, while left atrial stroke volume (LASV), left atrial dilation index (LAEI), and left atrial ejection fraction (LAEF) levels were significantly lower than those in the non-myocardial suppression group (P<0.05). Serum sST2, cTnI, LVPWd, and LVPWs levels in the survival group were significantly lower than those in the death group, while LASV, LAEI, and LAEF levels in the survival group were significantly higher than those in the death group (P<0.05). ROC curve analysis results showed that serum sST2 and cTnI combined with bedside echocardiography has certain diagnostic value for sepsis-induced myocardial depression, and the area under the curve (AUC) of the combined detection was 0.991, with a sensitivity of 93.60% and a specificity of 97.52%.

sST2 and cTnI combined with bedside echocardiography can improve the diagnostic efficacy of sepsis-induced myocardial depression patients.

To investigate the incidence and risk factors of anal fistula after surgery for acute perianal abscess, and to establish and validate a nomogram model for predicting the risk of anal fistula in the early postoperative period.

A total of 144 patients with acute perianal abscess admitted to Xi'an Central Hospital Affiliated to Xi'an Jiaotong University from January 2023 to January 2025 were enrolled as the research subjects, including 104 males and 40 females, aged 21-79 years (mean age 50.77±6.23 years). All patients were categorized into an anal fistula group (n=44) and a non-anal fistula group (n=100) according to whether anal fistula was diagnosed within 3 months after surgery. Clinical data of all patients were collected, including gender, age, body mass index (BMI), smoking history, drinking history, hypertension, constipation, diabetes mellitus, hypertension, abscess size, location and depth, preoperative fever history, preoperative antibiotic use, history of abscess and origin of pathogenic bacteria. Variables with P<0.05 in univariate analysis were included in the multivariable Logistic regression model to identify independent risk factors. A nomogram prediction model was constructed based on statistically significant indicators, and model validation was completed.

The incidence of anal fistula was 30.6% (44/144). There were no statistically significant differences in age, BMI, smoking history, drinking history, hypertension, abscess size, constipation, preoperative fever history, abscess location and preoperative antibiotic use between the anal fistula group and the non-anal fistula group (P>0.05). However, statistically significant differences were found in gender, diabetes mellitus, depth of abscess, pathogenic bacteria origin and history of abscess between the two groups (P<0.05). Logistic regression analysis showed that male gender, diabetes mellitus, depth of abscess, intestinal origin of pathogenic bacteria, and history of abscess were independent risk factors for anal fistula after surgery for acute perianal abscess (P<0.05). The concordance index (C-index) of the nomogram model for predicting the risk of anal fistula after acute perianal abscess surgery was 0.844, indicating good discrimination. The calibration curve was close to the ideal reference line, and the predicted values were generally consistent with the observed values. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) was 0.945 (95%CI: 0.915-0.979), suggesting that the nomogram model had favorable predictive discrimination.

Male gender, diabetes mellitus, depth of abscess, intestinal origin of pathogenic bacteria, and history of abscess are independent risk factors for anal fistula after acute perianal abscess surgery. The nomogram model may provide a useful reference for the early clinical identification of high-risk patients and for optimizing treatment decisions, although external validation is still needed.

To investigate the correlation of plasma D-dimer (D-D) and serum oxidized low-density lipoprotein (ox-LDL) with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, disease severity and short-term prognosis in patients with acute cerebral infarction (ACI).

A total of 146 patients with ACI admitted to Tongchuan Mining Bureau Central Hospital from October 2021 to October 2024 were enrolled, including 86 males and 60 females, aged 25~76 years [(52.94±7.45) years]. According to the TOAST clssification, patients were divided into five subtypes: large-artery atherosclerosis (LAA), cardioembolism (CE), small-artery occlusion (SAO), stoke of other determined etiology (SOE), and stoke of undetermined etiology (SUE). Plasma D-D and serum ox-LDL levels were compared among different TOAST subtypes. Disease severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and patients were divided into mild (n=51), moderate (n=67), and severe (n=28) groups. The modified Rankin Scale (mRS) was used to evaluate prognosis at 3 months after treatment, and patients were grouped according to their mRS scores. Spearman correlation analysis was performed to analyze the correlations of plasma D-D and serum ox-LDL with disease severity and short-term prognosis in ACI patients.

Plasma D-D level was the highest in the CE subtype, followed by LAA subtype, and the lowest in SAO subtype (P<0.05). No significant difference in D-D level was found between SAO and SUE subtypes patients (P>0.05). Serum ox-LDL level was the highest in LAA subtype, followed by the SAO subtype, then the CE subtype, and the lowest in SUE subtype (P<0.05). Plasma D-D and serum ox-LDL levels increased with the severity of the disease, and both were positively correlated with NIHSS scores (r=0.713 and 0.679, both P<0.05). D-D and ox-LDL levels increased with higher mRS scores, and both were positively correlated with short-term prognosis scores (r=0.802 and 0.749, both P<0.05).

Plasma D-D and serum ox-LDL levels differ among patients with different TOAST subtypes, and both are correlated with disease severity and short-term prognosis in ACI patients..

To evaluate the clinical efficacy and safety of stepwise integrated traditional Chinese and Western medicine therapy versus conventional Western medicine alone in patients with severe pulmonary tuberculosis complicated with respiratory failure.

A prospective randomized controlled trial was conducted in 80 patients with severe pulmonary tuberculosis complicated by respiratory failure admitted to Shaanxi Provincial Tuberculosis Prevention and Treatment Hospital from August 2022 to August 2024, including 46 males and 34 females, aged 31-78 years [(56.35±9.58) years]. Patients were randomly assigned by a random number table method to either the control group or the observation group, with 40 patients in each group. The control group received conventional Western medicine treatment, while the observation group received stepwise integrated traditional Chinese and Western medicine treatment on the basis of the same Western medicine regimen. The study compared the clinical efficacy, time to resolution of clinical symptoms, pulmonary function parameters [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF)], inflammatory cytokines [interferon-gamma (IFN-γ), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)], and the incidence of adverse drug reactions between the two groups.

The total clinical effective rate in the observation group was significantly higher than that in the control group (P<0.05). The time to resolution of clinical symptoms (including fever, cough, dyspnea, etc.) in the observation group was significantly shorter than that in the control group (P<0.05). After treatment, FEV1, FVC and PEF were significantly increased in both groups compared with baseline values, and the increases in the observation group were significantly greater than those in the control group (P<0.05), the serum levels of IFN-γ, IL-6 and TNF-α were significantly decreased in both groups, and the decreases in the observation group were significantly greater than those in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse drug reactions between the two groups (P>0.05), and no severe adverse reactions were observed in either group.

Stepwise integrated traditional Chinese and Western medicine therapy can significantly reduce systemic inflammatory response, effectively relieve clinical symptoms, and improve pulmonary function in patients with severe pulmonary tuberculosis complicated with respiratory failure, with no increase in adverse drug reactions, suggesting a favorable efficacy and safety profile.

To investigate the efficacy of hyperbaric oxygen therapy in patients following minimally invasive evacuation of intracranial hematoma.

A retrospective study was performed on 126 patients with intracerebral hemorrhage admitted to the Department of Neurosurgery, The First People's Hospital of Chun'an County between August 2022 and August 2024, including 82 males and 44 females, aged 40~70 years [(58.17±10.69) years]. The participants were assigned to an observation group and a control group according to whether hyperbaric oxygen (HBO) therapy was administered, with 63 patients in each group. Patients in the control group received minimally invasive hematoma evacuation for intracerebral hemorrhage. The observation group received HBO therapy within 24 hours after surgery. The primary endpoint was the National Institutes of Health Stroke Scale (NIHSS) score at postoperative day 14. Secondary endpoints included the temporal changes in postoperative NIHSS scores, cerebral edema volume, oxidative stress levels [malondialdehyde (MDA)、glutathione peroxidase (GSH-Px), superoxide dismutase (SOD)], and adverse events. Pearson correlation analysis was adopted to explore the correlation between oxidative stress indicators and NIHSS scores at the same time point.

Two-way repeated-measures analysis of variance revealed statistically significant main effects of group, main effects of time, and group-by-time interaction effects for NIHSS score, cerebral edema volume, and oxidative stress indicators including MDA, GSH-Px and SOD (all P<0.05). Simple effect analyses indicated that the NIHSS score, cerebral edema volume and MDA level gradually decreased over time, while GSH-Px and SOD levels gradually increased in both groups. No significant intergroup differences in the above indicators were observed before operation (P>0.0125). At postoperative day 3, 7 and 14, the observation group exhibited lower NIHSS scores, smaller cerebral edema volume and lower MDA levels, as well as higher GSH-Px and SOD levels compared with the control group (all P<0.0125). Correlation analysis showed that the NIHSS score at each time point was positively correlated with the concurrent MDA level, and negatively correlated with concurrent GSH-Px and SOD levels (all P<0.05). There was no statistically significant difference in the incidence of adverse events between the two groups (P>0.05).

Hyperbaric oxygen therapy after minimally invasive hematoma evacuation for intracerebral hemorrhage reduces cerebral edema, decreases oxidative stress levels, and improves neurological function.

To investigate the effect and clinical application value of propofol combined with midazolam on neurological function in patients with acute cerebral hemorrhage undergoing hematoma evacuation.

A total of 100 patients undergoing surgery for acute cerebral hemorrhage admitted to Shenmu Municipal Hospital from January 2022 to December 2024 were enrolled as research subjects, including 56 males and 44 females, aged 42~70 years [(52.44±6.02) years]. The patients were divided into a control group (n=50) and an observation group (n=50) by the random number table method. The control group received anesthesia with propofol alone, while the observation group received anesthesia combined with propofol and midazolam. Differences between the two groups were compared in vital signs [mean arterial pressure (MAP), heart rate (HR)], oxidative stress indicators [malondialdehyde (MDA), cortisol (Cor), norepinephrine (NE)], nerve injury factors [neuron-specific enolase (NSE), S100β protein (S100β)], National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, anesthetic efficacy and safety indicators. Safety indicators contained anesthesia induction time, extubation time, post anesthesia care unit (PACU) stay time, incidence of intraoperative hypotension, dosage of vasoactive drugs, length of intensive care unit (ICU) stay, incidence of postoperative delirium and pulmonary infection.

There was a significant group × time interaction effect for HR and MAP (P<0.05). Simple effect analysis showed no intergroup differences in baseline vital signs (P>0.05). From T₂ to T₄ after operation, HR and MAP in the observation group were significantly lower. Vital signs remained stable throughout the observation period in the observation group, whereas obvious elevations in these indicators were observed in the early postoperative stage in the control group. The levels of MDA, Cor and NE at 48 h after operation were increased compared with preoperative levels in both groups; these indicators at 48 h postoperatively in the observation group were lower than those in the control group at the same time point (P<0.05). Meanwhile, the levels of NSE and S100β at 48 h after operation in the observation group were also significantly lower than those in the control group (P<0.05). Repeated-measures analysis of variance revealed statistically significant intergroup differences in NIHSS scores and mRS scores (both P<0.05). Pairwise comparisons after Bonferroni correction demonstrated that NIHSS and mRS scores at 1 month and 6 months postoperatively were lower than preoperative values in both groups, and scores at 6 months postoperatively were further decreased compared with those at 1 month postoperatively (P<0.05). The NIHSS and mRS scores of the observation group at 1 month and 6 months after surgery were lower than those of the control group at the corresponding time points (P<0.05). In addition, the observation group had shorter extubation time and PACU stay time, along with a lower incidence of intraoperative hypotension and less consumption of vasoactive drugs (P<0.05).

Anesthesia with propofol combined with midazolam in acute cerebral hemorrhage surgery can effectively stabilize patients' vital signs, alleviate oxidative stress response, improve anesthetic efficacy, and facilitate the recovery of neurological function, demonstrating substantial clinical benefits.

To explore and construct a risk prediction model for refractory postpartum hemorrhage in postpartum women and to preliminarily evaluate its predictive efficacy.

A total of 500 postpartum patients who met the inclusion and exclusion criteria and were admitted to Linhai Maternal and Child Health Hospital from January 1, 2024 to January 1, 2025 were selected as the study subjects, aged 20~42 years [(30.71±5.02) years]. They were randomly divided into a training group (n=350) and a validation group (n=150) in a 7∶3 ratio. The incidence of refractory postpartum hemorrhage in the training group was assessed, and patients were divided into a refractory postpartum hemorrhage group (n=32) and a non-refractory postpartum hemorrhage group (n=318). Risk factors for refractory postpartum hemorrhage were identified, and a Nomogram prediction model was constructed. Receiver operating characteristic (ROC) curves were used to measure the predictive accuracy of the model, and clinical decision curve analysis (DCA) was used to evaluate the clinical utility of the model.

There were statistically significant differences between the two groups in history of scarred uterus, placenta previa, placental abruption, placental adhesion/invasion/penetration, coagulation dysfunction, uterine atony, prenatal serum coagulation factor Ⅶ (FⅦ) and fibrinogen (FIB) (P<0.05). Multivariate logistic regression analysis showed that history of scarred uterus, placenta previa, placental abruption, placental adhesion/implantation/penetration, coagulation dysfunction, uterine atony, prenatal FVII≥161 U, and prenatal FIB≥3.0 g/L were independent risk factors for refractory postpartum hemorrhage in women who had given birth (P<0.05). The area under the curve (AUC) of the nomogram model was 0.862 (95%CI: 0.833-0.925) in the training group and 0.834 (95%CI: 0.754-0.887) in the validation group. ROC curve analysis determined an optimal risk probability cutoff of 28%. At this threshold, the sensitivity and specificity were 81.17% and 78.64% in the training group, and 75.33% and 72.54% in the validation group, respectively. DCA analysis showed that when the threshold probability set by clinical decision-makers was 28%, the model had a higher net benefit than the full-intervention or no-intervention strategy, suggesting that it has certain clinical decision-making value.

The occurrence of refractory postpartum hemorrhage in postpartum women is associated with factors such as history of scarred uterus, placenta previa, placental abruption, placental adhesion/implantation/penetration, coagulation dysfunction, uterine atony, FVII, and FIB. Constructing a predictive model can provide a reference for subsequent risk assessment and intervention studies of high-risk groups.

To explore the application value of intelligent emergency triage platform combined with green channel transport management in patients with acute myocardial infarction (AMI).

A total of 80 AMI patients admitted to the Emergency Department of the Second Affiliated Hospital of Shantou University Medical College from January 2024 to December 2024 were enrolled as research subjects, including 47 males and 33 females, with an age of 42~71 years [(56.6±7.35) years]. The primary endpoint was defined as door-to-balloon (D2B) time. Secondary endpoints included length of hospital stay, in-hospital complications, and 3-month major adverse cardiovascular events. The rate of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow was set as an exploratory outcome indicator. Patients were divided into a control group and an observation group according to the launch time of the in-hospital intelligent emergency triage platform, with 40 cases in each group. The control group consisted of patients admitted from January 2024 to June 2024 before the implementation of the intelligent emergency triage platform, who received routine emergency management. The observation group included patients admitted from July 2024 to December 2024 after the implementation of intelligent emergency triage platform combined with green-channel transfer management. Medical records were retrieved to compare indicators such as emergency efficiency (pre-hospital emergency response time, emergency triage time, D2B time), length of hospital stay, complications, and adverse cardiovascular events during follow-up between the two groups.

The pre-hospital emergency response time, emergency triage time, primary endpoint D2B time and hospital stay in the observation group were significantly shorter than those in the control group (P<0.05). The rate of achieving TIMI grade 3 blood flow was 82.50% in the control group and 97.50% in the observation group, showing an increasing trend without statistically significant intergroup difference (P>0.05). The total incidence of complications and adverse cardiovascular events within 3-month follow-up were lower in the observation group (P<0.05).

The combination of intelligent emergency triage platform and green channel transport management can optimize the emergency treatment process of AMI patients, shorten D2B time, improve rescue efficiency, reduce hospital stay and the risk of short-term adverse events. The improvement in TIMI 3 flow rate only showed a trend, which needs verification in studies with larger sample sizes.

Construct a smart cloud platform for stroke within the medical community, and explore the establishment and application of an integrated stroke care system supported by the general hospital of the medical community, relying on township health centers and community health service stations, and based on home care.

A prospective non-concurrent controlled study was adopted. A total of 291 stroke patients discharged from the Department of Neurology, Tiantai People's Hospital between October 2023 and September 2024 were enrolled as research subjects, including 168 males and 123 females, aged 35~80 years [(65.59±9.50) years]. Subjects were divided into an observation group (n=146) and a control group (n=145) according to discharge sequence. The control group received routine discharge guidance, with follow-up conducted via telephone combined with outpatient visits after discharge. Supported by an intelligent cloud platform, the observation group received continuous nursing under an integrated stroke care system within the medical community consortium. Real-time online interaction was performed through the stroke cloud platform, supplemented by home visits and home-based care. After intervention, the compliance of healthy behaviors including regular medication, rational diet and rehabilitation training was compared between the two groups. The control status of high-risk factors such as blood pressure, blood glucose and blood lipids was analyzed. The Modified Barthel Index (MBI) scale was used to evaluate the quality of life of patients in both groups.

At 6 months after discharge, the observation group obtained higher compliance scores of medication adherence, rational diet and rehabilitation training than the control group (P<0.001). Statistically significant differences in high-risk factor control status and readmission rate were identified between the two groups at 6 months after discharge (P<0.05), with better indicator improvements observed in the observation group. MBI scores of both groups were improved at 6 months after discharge compared with the values at discharge; the observation group had significantly higher MBI scores than the control group at the 6-month follow-up (P<0.001). During follow-up, the incidence of adverse events was 8.28% in the control group, while no adverse events occurred in the observation group, suggesting good safety of this model.

The integrated stroke care model based on the smart cloud platform of the medical consortium can effectively improve patients' compliance with health behaviors, facilitate the control of high-risk factors, and thereby enhance patients' quality of life.