To investigate the current status of surrogate decision-making on the downward referral of stranded patients in the emergency resuscitation room of a tertiary hospital and to analyze its influencing factors, so as to provide a basis for promoting the rational transfer of patients and optimizing the allocation of medical resources.

A total of 330 stranded patients in the emergency resuscitation room of Zhujiang Hospital of Southern Medical University and their surrogate decision-makers were selected as research subjects by convenient sampling from July 2024 to October 2024. Among them,there were 163 male cases (49.4%) and 167 female cases (50.6%), with ages ranging from 30 to 99 years and a mean age of (77.81±12.11) years. For surrogate decision-makers, 164 were males (49.7%) and 166 were females (50.3%), with ages ranging from 23 to 84 years and a mean age of (35.29±11.42) years. According to the scores on the Decision Conflict Scale, the participants were divided into the no decision conflict group (n=125) and the decision conflict group (n=205). A questionnaire survey was carried out with a general information questionnaire, and the decision participation expectation scale and the decision conflict scale, and multiple stepwise linear regression was adopted to analyze the influencing factors.

The decision conflict score of surrogate decision-makers was 31.25 (18.75, 40.62). Multiple stepwise linear regression analysis showed that familiarity with medical institutions, awareness of the hierarchical diagnosis and treatment system, distance between residence and hospital, educational level and relationship with the patient were the main influencing factors, with all differences statistically significant (all P<0.05), which could explain 68.8% of the total variation.

Surrogate decision conflict is common and at a moderate level. Medical staff should strengthen referral information support, health education on the hierarchical diagnosis and treatment system and other measures to reduce decision conflict of surrogate decision-makers and improve decision-making quality.

To compare the effects of laparoscopic surgery, interventional embolization and open surgery on coagulation function, arterial blood flow and inflammatory response in patients with ectopic pregnancy rupture.

Ninety nine patients with rupture of ectopic pregnancy admitted to Yulin first hospital from January 2021 to January 2025 were selected; The average age was (31.18±7.82) years, ranging from 28 to 51 years. According to the random number table, the patients were randomly divided into laparoscopic group, interventional embolization group and open surgery group, with 33 cases in each group. Coagulation function indexes [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB)], arterial blood flow indicators [resistance index (RI), pulsatility index (PI), systolic/diastolic ratio (S/D)], and serological indicators [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), thromboxane A2 (TXA2), cyclooxygenase-2 (COX-2)] were detected before and 48 h after surgery, and the occurrence of adverse pregnancy outcomes was recorded.

At 48 h after operation, the prothrombin time, coagulation time, activated partial thromboplastin time levels in the laparoscopic group were lower than those in the interventional embolization group and the open surgery group, and the fibrinogen level was higher than the other two groups.The levels of RI, PI, S/D, TNF-α, IL-6, TXA2, and COX-2 in the laparoscopic group were lower than those in the other two groups; The incidence of adverse pregnancy outcomes in the laparoscopic group was significantly lower than that in the other two groups(P<0.05).

Laparoscopic surgery for ruptured ectopic pregnancy can better maintain coagulation function, preserve hemodynamic stability, reduce inflammatory response, and lower the incidence of adverse pregnancy outcomes.

To explore the regulatory effect of vitamin D pulse therapy on bone metabolism markers and bone mineral density in critical patients of chronic osteomyelitis after trauma.

A retrospective analysis was conducted on 80 critically ill patients with post-traumatic chronic osteomyelitis admitted to the Third People's Hospital of Yangzhou City from June 1, 2021 to May 2024. This study used a case-control study sampling, with 46 males and 34 females; The age ranged from 35 to 66 years old, with an average of (52.95±2.61) years. According to the treatment method, the patients were divided into an observation group and a control group, with 40 cases in each group. The control group received antibacterial treatments such as benzylpenicillin and clindamycin, while the observation group received vitamin D shock therapy in addition to the control group. Both groups were treated for 6 months. Compare the recovery status of two groups, including bone metabolism markers [osteocalcin (OC), type I collagen carboxy terminal peptide (CTX-I)], bone density, white blood cell count (WBC), and erythrocyte sedimentation rate (ESR) after 3 months and 6 months of treatment, and compare the incidence of adverse reactions during treatment.

Compared with the baseline before treatment, the levels of OC significantly increased and CTX-I levels significantly decreased at 3 and 6 months after treatment in both patient groups, with statistically significant differences (P<0.05); compared with 3 months of treatment in the same group, OC levels further increased and CTX-I levels further decreased at 6 months after treatment in both patient groups, and the differences were statistically significant (P<0.05). At 3 months after treatment, the observation group had higher OC level and lower CTX-I level than the control group (P<0.05); at 6 months after treatment, the observation group still showed higher OC level and lower CTX-I level relative to the control group, with statistically significant differences (P<0.05). The bone mineral density of both groups was significantly elevated at 3 and 6 months after treatment compared with the baseline before treatment (P<0.05), and the bone mineral density at 6 months after treatment was higher than that at 3 months after treatment in the same group (P<0.05); the observation group presented higher bone mineral density than the control group at both 3 and 6 months after treatment (P<0.05). In addition, the levels of WBC and ESR were markedly reduced at 3 and 6 months after treatment in both patient groups when compared with pretreatment levels (P<0.05), and further decreased at 6 months after treatment compared with 3 months after treatment within each group (P<0.05); the observation group had lower WBC and ESR levels than the control group at 3 and 6 months after treatment, with statistically significant differences (P<0.05)

Vitamin D shock therapy has a good effect on critically ill cases of chronic osteomyelitis after trauma, which can improve bone metabolism markers and bone density.

To explore the risk factors of human immunodeficiency virus (HIV) infection among voluntary blood donors in Ankang City from 2021 to 2024, and to select a scientifically reasonable screening strategy to reduce the risk of HIV transmission through blood transfusion.

From June 2021 to January 2024, 120,357 voluntary blood donors in Ankang Central Blood Station were divided into male (n=74,910) and female (n=45,447) groups. All samples were tested for HIV, screening-positive samples were confirmed by western blot (WB). According to the WB confirmation results, subjects were divided into the HIV-infected group (n=11) and the non-HIV-infected group (n=120,346). The HIV infection rates of the male group and female group were calculated. Demographic data and high-risk behaviors were collected. Univariate analysis and multivariate Logistic regression were applied to analyze related and independent risk factors for HIV infection.

From June 2021 to January 2024, among 120,357 voluntary blood donors in Ankang City, 264 cases (0.22%) were initially screened positive. Among them, 11 cases (0.0914‰) were confirmed positive by WB confirmation test. Eight of the positive cases were male and three were female. The age group of the HIV-infected group was 18-45 years old, male, with a educational level of junior high school or below, the AIDS awareness status was no, no AIDS-related education received, no HIV test before diagnosis, and the proportion of having high-risk behaviors was all higher than that of the non-HIV-infected group (P<0.05). Logistic multivariate regression analysis showed that age of 18-45 years old, gender as male, educational level of junior high school or below, AIDS awareness status as no, no AIDS-related education received, no HIV test before diagnosis, and having high-risk behaviors were all risk factors for HIV infection among blood donors in Ankang City (P<0.05).

HIV prevalence is low among blood donors in Ankang City and closely linked to high-risk behaviors like unprotected sex. Age, occupation and education significantly affect infection risk, and male blood donors have a higher HIV prevalence than females.

To explore the comparison of pulse-indicated continuous cardiac output and central venous pressure-guided volume expansion on hemodynamics in patients with septic shock complicated with myocardial depression.

84 patients with septic shock and myocardial depression admitted to Xi'an Red Cross Hospital from January 2023 to January 2025 were selected as the research subjects, with 42 cases in each group. There were 22 males and 20 females in the observation group, aged 41-62 years [(53.71±4.26) years]. The control group consisted of 24 males and 18 females, aged 40-64 years [(53.75±4.24) years]. Patients in the control group received volume resuscitation guided by central venous pressure, while those in the observation group were treated with pulse indicator continuous cardiac output monitoring. The hemodynamics [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure (CVP)], urine volume and urine balance volume before treatment, 24 hours after treatment and 48 hours after treatment were compared between the two patient groups, the blood gas indicators [oxygenation index (PaO₂/FiO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂)], Acute Physiology and Chronic Health score (APACHE-II), Sequential Organ Failure Assessment (SOFA) scale before treatment and one week after treatment were compared between the two patient groups, at discharge, the mechanical ventilation time, the length of stay in the ICU, and the mortality rate during the 28-day follow-up were compared between the two patient groups.

There was a significant interaction between time and group for SBP, DBP, MAP, and CVP in both patient groups (P<0.05). At 24 h and 48 h after treatment, the observation group exhibited lower SBP and DBP but higher MAP and CVP compared to the control group (P<0.05). Significant interactions were also observed for urine output and fluid balance between time and group (P<0.05). At 24 h and 48 h after treatment, the observation group showed higher urine output and fluid balance than the control group (P<0.05). After one week of treatment, the observation group had higher PaO₂/FiO₂ and PaCO₂ levels than the control group (P<0.05). Additionally, the observation group demonstrated lower APACHE-II and SOFA scores than the control group (P<0.05). The observation group required shorter durations of mechanical ventilation and ICU stays (P<0.05), and had a lower 28-day mortality rate compared to the control group (P<0.05).

Compared with volume expansion guided by central venous pressure, continuous cardiac output indicated by pulse has more obvious improvement on hemodynamics in septic shock complicated with myocardial depression, which can improve blood gas indicators and reduce mortality.

To study the therapeutic effect of ultrasound-guided PRP injection combined with Mulligan dynamic joint mobilization for the treatment of acute ankle sprain.

90 patients with acute ankle sprain in Shaanxi Provincial Traditional Chinese Medicine Hospital from February 2022 to March 2024. Among them, there were 57 males and 33 females; age range of 40~70 years, with an average of (41.85±7.34) years. According to the random number table method,they were divided into research group and control group, 45 cases each. Both groups were given etofenate gel, on this basis, the control group was treated with Mulligan dynamic joint mobilization, the research group used ultrasound-guided PRP injection combined with Mulligan dynamic joint mobilization for treatment. Both groups were treated for one month, the excellent and good ankle joint function rates, AOFAS scores, VAS scores, and active range of motion of ankle joint (dorsiflexion, plantarflexion, varus, valgus) were compared between two patient groups after 1 months of treatment, the hemodynamic parameters of the dorsal foot artery on the affected side [peak systolic blood flow velocity (SF), mean blood flow velocity (TAM), resistance index (RI)] were compared after 1 months of treatment.

The excellent rates of ankle joint function in the study group was higher than that in the control group, and the AOFAS score, ankle joint active range of motion, SF, and TAM levels were higher than those in the control group (P<0.05); the VAS score and RI level of the study group patients were lower than those of the control group (P<0.05).

Ultrasound guided PRP injection combined with Mulligan dynamic joint mobilization can effectively improve ankle joint function, alleviate pain, promote blood circulation, and have significant clinical efficacy in patients with acute ankle sprain.

To investigate the effects of different doses of oxycodone combined with dexmedetomidine on blood oxygen saturation and emergence agitation in patients undergoing laparoscopic cholecystectomy (LC).

A total of 270 elective LC patients treated at Ankang Central Hospital from June 2021 to December 2024 were enrolled (117 males, 153 females; aged 36-55 years, mean 46.8±9.9 years). Using a computer-generated random number table, patients were assigned to group A (oxycodone 0.05 mg/kg), group B (0.15 mg/kg), or group C (0.25 mg/kg) during anesthesia induction; all groups received dexmedetomidine 0.5 µg/kg, 90 cases in each group. Saturation of peripheral oxygen (SpO₂), sedation agitation scale(SAS), heart rate (HR), mean arterial pressure (MAP), postoperative visual analogue scale (VAS), and adverse events were compared among the three groups at pre-induction, extubation, and 30 min post-operatively.

No baseline differences (age, gender, BMI, ASA, operation/anesthesia time, comorbidities, smoking) across groups (P>0.05). Group C showed lower 1/6/12 h VAS vs A/B (P<0.001), but reduced SpO₂ at extubation and 30 min post-op (P<0.05). Intraoperative and extubation HR/MAP were minimal in Group C (P<0.001). Its 51.1% adverse event rate exceeded low-dose groups’ 17.8% (P<0.001). Agitation rates rose by dose (11.1%, 16.7%, 24.4%), no statistical difference (P>0.05).

Oxycodone combined with dexmedetomidine improves post-operative analgesia after laparoscopic cholecystectomy; however, higher doses may increase the risks of respiratory depression, hemodynamic fluctuation, and emergence agitation.

To investigate the application effect of a stepped targeted temperature management strategy in patients with severe subarachnoid hemorrhage (SAH).

Clinical data of 80 patients with severe SAH admitted to Shuyang Hospital Affiliated to Xuzhou Medical University from September 2021 to October 2024 were retrospectively analyzed, including 51 males and 29 females, aged 51~75 years, with a mean age of (65.03±5.31) years. Thirty-eight patients who received conventional temperature management from September 2021 to March 2023 were assigned to the control group, and 42 patients who received the targeted temperature management strategy (target temperature 36 ℃) from April 2023 to October 2024 were assigned to the observation group. Interventions in both patient groups were performed until discharge. Body temperature data were collected before intervention and at 12, 24, and 48 hours after intervention. National Institutes of Health Stroke Scale (NIHSS) scores were recorded before intervention, at 48 hours after intervention, and at discharge. Hunt-Hess grades before intervention and at discharge, as well as the incidence of complications in both patient groups, were also collected.

Repeated-measures analysis of variance showed significant intergroup and temporal effects on body temperature between the two patient groups (P<0.05), with a significant interaction between time points and groups (P<0.05). Simple effect analysis with Bonferroni correction revealed that body temperature in the observation group was lower than that in the control group at 12, 24, and 48 hours after intervention (P<0.05), and the achievement rate of the target temperature (36 ℃) at 48 hours in the observation group was higher than that in the control group (P<0.05). Repeated-measures analysis of variance also showed significant intergroup and temporal effects on NIHSS scores between the two patient groups (P<0.05), with a significant interaction between time points and groups (P<0.05). Simple effect analysis with Bonferroni correction indicated that NIHSS scores in the observation group were lower than those in the control group at 48 hours after intervention and at discharge (P<0.05). At discharge, the Hunt-Hess grade in the observation group was superior to that in the control group (P<0.05), and the total incidence of complications in the observation group was lower than that in the control group (P<0.05).

The stepped targeted temperature management strategy (target temperature 36 ℃) is conducive to controlling body temperature, reducing the incidence of complications in patients with severe SAH, and possesses favorable clinical application value.