Observation Group Research Articles

Dynamics of changes in heart rate, ST segment and T-wave on patients with ventricular rhythm disturbances on the background of type 2 diabetes mellitus according to the results of 24-hour cardiac monitoring

The aim of the study was to analyze the dynamics of heart rate, assess the morphogenesis of the ST segment and T wave in patients with ventricular arrhythmias associated with type 2 diabetes mellitus (type 2 DM) based on the results of daily cardiac monitoring against the background of two regimens of metabolitotropic treatment. The study included 133 patients with type 2 DM with ventricular arrhythmias. The inclusion criteria for the study were: moderately severe type 2 diabetes in the stage of sub-/compensation on the background of combined glucose-lowering therapy without insulin, the presence of ventricular arrhythmias of classes III–V according to Lown B. and Wolf M. (1971). By random sampling, patients were randomized into 3 observation groups, statistically homogeneous in age, sex, duration of the diabetic syndrome, classes of ventricular arrhythmias. Patients of the 1st group (n = 44) received amiodarone and beta-blocker. Patients of the 2nd group (n = 45) received the same antiarrhythmic treatment, but in combination with meldonium for 3 consecutive months with the next 3-month course repeated after 6 months. Representatives of the 3rd group (n = 44) received treatment with amiodarone, beta-blocker and trimetazidine of the same duration. 24-hour ECG monitoring was performed at baseline, 3 months later, and 1 year later. Statistica 6.0 software was used for statistical processing. The examination revealed tachycardia syndrome and signs of pain and painless myocardial ischemia. It has been established that ventricular arrhythmias in type 2 DM are of a secondary nature, largely dependent on ischemic manifestations. Trimetazidine compared with meldonium showed a greater anti-ischemic effect, which made it possible to obtain a better antiarrhythmic effect. Trimetazidine is considered as one of the justified components of the treatment of ventricular arrhythmias of ischemic origin in patients with type 2 DM.

Monitoring of several morphometric parameters of the optic nerve and retina in persons without glaucoma and patients with primary open-angle glaucoma using various types of spectacle correction

Purpose: to perform long-term monitoring of the state of several morphometric parameters of the retina and optic nerve in persons without glaucoma and patients with primary open-angle glaucoma (POAG) in the conditions of achieving tolerant and target IOP against the background of the use of various types of spectacle correction. Material and methods: 139 patients aged 40–60 years with various types of clinical refraction were examined, 41 subjects (81 eyes) of them were without glaucoma, 98 patients (164 eyes) had POAG at stage I–II. In addition to standard methods, the scope of the examination included optical coherence tomography (OCT) of the optic nerve and the central area of the retina to determine the thickness of the retinal nerve fiber layer (RNFL), retinal ganglion cell complex (RGCC) and the area of the neuroretinal rim (NRR). The study was conducted in 4 observation groups. The first (21subjects) and the second (20 subjects) groups were represented by persons without glaucoma who used monofocal spectacle correction and progressive spectacle correction for near work, respectively. The third (50 subjects) and the fourth (48 subjects) groups were composed of patients with POAG who also used, respectively, monofocal spectacle correction for near vision or progressive spectacle correction against the background of topical hypotensive therapy with the achievement of tolerant and target IOP. The follow-up period was three years. Results: There were no significant changes in the area of NRR (p 0,5) and in the thickness of RNFL (p 0,2) and RGCC (p 0,3) over the three-year follow-up period in all patients without glaucoma. In patients with POAG who applied progressive correction, no negative dynamics was revealed in the NRR area (p 0,5) and in the thickness of RNFL (p 0,5) and RGCC (p 0,5) during the follow-up period. POAG patients with using monofocal correction had noticeable losses in RNFL and RGCC thickness (p 0,05) without a significant decrease in the area of NRR (p 0,3). Conclusion: The progressive spectacle correction using provides accommodative regulation of IOP in POAG and implements an indirect neuroprotective effect.

Indigenous Experiences and Contributions to Western Scientific Knowledge Systems: An Ethnographic Exploration

Knowledge systems are embedded in sets of values, worldviews, and cosmologies that affect the whole process of knowledge production. Employing an ethnographic method that integrates participant observation, interviews, and focus groups, I explore the contributions, ideas, points of view, and metaphors that individuals of Indigenous origins introduce to the scientific method when they enter Western scientific knowledge systems. This ethnographic exploration focuses on a group of students with a variety of Indigenous backgrounds participating in a field course on introduction to Ecology. Native-born students contribute innovations to the knowledge production process by shaping research questions, methodologies, and result interpretations. These innovations stem from diverse worldviews and epistemologies, and while they could significantly impact scientific knowledge production, the students may not fully appreciate their own relevance. This work may serve as a testimony of the processes of reflection and negotiation with the scientific methods, practices, and values that native students undergo when participating in a Western scientific context.

The impact of early speech and language cognitive training care on the developmental quotient of children with language impairments: A retrospective study.

This study aims to investigate the effects of early speech and language cognitive training on the nursing outcomes of children with language impairments and their impact on developmental quotient. From October 2018 to October 2023, the data of 80 children with language impairments treated at our hospital were selected. They were divided into an observation group (n = 40) and a control group (n = 40) based on the treatment plan. The control group received routine rehabilitation training, while the observation group received early cognitive language rehabilitation training. The treatment efficacy of the 2 groups, as well as differences in Gesell Developmental Schedule scores and serum indicators before and after treatment, were observed and analyzed. The treatment efficacy in the observation group was superior to that in the control group (P < .05), with a total effective rate of 92.50% in the observation group. After 6 months of treatment, the scores for adaptability, gross motor skills, fine motor skills, personal-social behavior, and language development quotient in the observation group were (77.41 ± 10.21), (77.15 ± 10.43), (80.43 ± 11.19), (71.14 ± 10.42), and (81.21 ± 12.03), respectively, significantly higher than those in the control group (P < .05). After 6 months of treatment, the mental development index and psychomotor development index in the observation group were (107.28 ± 10.43) and (96.60 ± 9.03), respectively, which were markedly higher than those in the control group (P < .05). After 6 months of treatment, the serum levels of insulin-like growth factor-1, 25-hydroxyvitamin D [25(OH)D3], and gamma-aminobutyric acid in the observation group were (52.43 ± 9.44) ng/mL, (31.45 ± 4.82) ng/mL, and (76.65 ± 10.54) µmol/mL, respectively. These levels were not significantly different from those in the control group (P > .05). The blood flow velocities of the middle cerebral artery, anterior cerebral artery, basal artery, and vertebral artery in the observation group and control group were compared after 6 months of treatment (P > .05). Early speech and cognitive training have shown promising efficacy in the treatment of language disorders, as it can improve developmental quotient in affected children and increase serum levels of insulin-like growth factor-1, 25(OH)D3, and gamma-aminobutyric acid.

Clinical study of isthmic spondylolisthesis treated with Mis-TLIF assisted by preoperative posture reduction and intraoperative lifting reduction

To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion(Mis-TLIF) technique combined with preoperative position reduction in the treatment of spondylolisthesis and summarize its advantages. Between July 2016 and July 2022, 60 patients with lumbar isthmic spondylolisthesis were retrospectively analyzed, including 26 males and 34 females, with an average age of (51.32±4.24) years old ranging from 35 to 72 years old. They were divided into observation group and control group according to the operation methods. There were 30 patients in the observation group, including 12 males and 18 females;the age ranged from 35 to 71 years old with an average of(51.80±6.38) years old, the course of disease ranged from 12 to 60 months with an average of (24.17±1.98) months;there were 18 cases of L4 spondylolisthesis and 12 cases of L5 spondylolisthesis;according to Meyerding classification, there were 20 cases of grade Ⅰ spondylolisthesis and 10 cases of gradeⅡ. The observation group was treated with preoperative postural reduction combined with intraoperative reduction assisted minimally invasive transforaminal lumbar fusion via Quadrant channel(Mis-TLIF). There were 30 patients in the control group, including 14 males and 16 females, with an average of (50.00±4.24) years old ranging from 36 to 72 years old;the course of disease ranged from 12 to 60 months with an average of (23.70±1.53) months;there were 16 cases of L4 spondylolisthesis and 14 cases of L5 spondylolisthesis;according to Meyerding classification, there were 19 cases of grade Ⅰ spondylolisthesis and 11 cases of grade Ⅱ. The control group was treated with open transforaminal lumbar interbody fusion(Open-TLIF). The differences of operation time, intraoperative and postoperative blood loss, hospital stay, radiation exposure time and complications between the two groups were analyzed. Visual analogue scale (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical effect. X-ray and CT were followed up to evaluate the interbody fusion. All patients were followed up for 12 months. There was no significant difference in operation time, VAS of low back pain, slip angle and slip rate between two groups (P>0.05). The intraoperative and postoperative blood loss in the observation group (165.50±15.56) ml and (59.17±10.59) ml were less than those in the control group (259.33±35.32) ml and (165.33 ±29.56) ml (P<0.05). The length of hospital stay in the observation group (3.53±0.68) days was less than that in the control group (5.20±0.41) days (P<0.05).The intervertebral space height, slip angle, slip rate, ODI, VAS and JOA scores were significantly improved in the two groups at the final follow-up (P<0.05). There were significant differences in ODI [(9.93±1.11)% vs (10.93±1.11)%] and JOA [ (26.07±1.01) points vs (25.43±1.25) points] between the observation group and the control group at the final follow-up (P<0.05). In the treatment of spondylolisthesis, preoperative position reduction combined with intraoperative reduction assisted Mis-Tlif technique has advantages of less trauma, less bleeding and shorter hospitalization period than traditional open surgery. It is a safe and effective technique.

Effectiveness of the re-engineered discharge (RED) care model in patients with rheumatoid arthritis.

This study aims to investigate whether the re-engineered discharge (RED) model can significantly improve the quality of life, enhance the health status, and reduce the levels of depression and anxiety in patients with rheumatoid arthritis during hospitalization. This study selected 108 rheumatoid arthritis patients treated at our facility between February 2023 and February 2024. Based on the different treatment methods, these patients were divided into a control group and an observation group, with 54 patients in each group. During hospitalization, both groups received standardized routine care provided by the hospital. After discharge, the control group continued with regular follow-up visits, while the observation group received a more comprehensive and multidimensional extended care based on the RED model. The intervention period for both groups was set to 3 months. The core observation indicators of this study focused on the emotional fluctuations, symptom improvement, and changes in self-care ability of the patients before and after the intervention. After the intervention, the scores of the Self-Rating Anxiety Scale and Self-Rating Depression Scale in both groups showed significant decreases, with the scores in the observation group being significantly lower than those in the control group, showing a highly significant statistical difference (P < .01). Additionally, the joint pain scores in both groups were alleviated, reflected by shorter morning stiffness times, reduced joint swelling, and increased grip strength. The observation group had lower joint pain scores, shorter morning stiffness times, fewer swollen joints, and stronger grip strength, all of which were statistically significant (P < .01). Furthermore, the distribution of self-care abilities in the observation group showed a significant difference compared to the control group (P < .05), with the observation group having a higher proportion of self-care abilities, which was also statistically significant (P < .05). For patients with rheumatoid arthritis, the implementation of the RED model nursing strategy can significantly alleviate negative emotions, reduce the distress caused by symptoms, and markedly improve their quality of life, providing a more comfortable and reassuring treatment experience.

Study on the clinical effect of meridian massage in the treatment of lumbar disc herniation

To observe the clinical efficacy of meridian massage in the treatment of lumbar disc herniation(LDH). Between July 2020 and April 2023, 82 patients with lumbar disc herniation were selected, including 58 males and 24 females, aged from 23 to 55 years old with an average of (43.76±6.64) years old. According to the different treatment methods, they were divided into observation group and control group with 41 cases in each group. The control group was treated with routine treatment, and the observation group was treated with meridian massage on the basis of routine treatment. In the control group, there were 30 males and 11 females;aged from 22 to 52 years old with an average of (42.27±9.34) years old;the Body mass index (BMI) ranged from 19 to 28 kg·m-2 with an average of(23.82±1.08) kg·m-2;the course of disease ranged from 0.5 to 3.0 years (2.40±0.48) years. There were 28 cases in L4,5 segment and 13 cases in L5S1 segment. In the observation group, there were 28 males and 13 females;the age ranged from 19 to 54 years old (42.19±9.26) years old;the BMI ranged from 18 to 29 kg·m-2 with an average of(23.73±1.15) kg·m-2;the course of disease ranged from 0.6 to 2.8 with an average of(2.56±0.45) years;there were 26 cases in L4,5 segment and 15 cases in L5S1 segment. Visual analogue scale(VAS), Oswestry disability index(ODI), M-JOA score and TCM syndrome score were measured before and after 3 courses of treatment, and the clinical efficacy was evaluated by the standard of curative effect evaluation. After treatment, VAS [(3.24±1.45) vs(4.46±0.64)], ODI [(11.45±1.98)% vs (17.21±2.74)%] and TCM symptom score [(2.03±0.27) vs (3.99± 0.54)] of the observation group were lower than those of the control group. The score of M-JOA [(23.43±2.61) vs (19.37±1.62)] increased (P<0.05). The scores of VAS, ODI and TCM symptoms in the observation group were lower than those in the control group, while the scores of M-JOA were higher than those in the control group (P<0.05). Meridian massage is effective in the treatment of LDH, which can effectivelyrelieve low back pain, improve clinical symptoms and increaselumbar function, which is worthy of clinical promotion.

Effect of clustered nursing on liver function indexes, nutrition, and emotional status of patients with severe liver failure.

Liver failure is a metabolic disorder caused by a variety of mixed factors. For such diseases, adopting cluster care can effectively improve the relevant symptoms of patients. To explore the nursing effect of nutritional nursing combined with clustered nursing for patients with severe liver failure. A total of 129 patients with severe liver failure were selected as retrospective study subjects. Nine cases were due to an end event, such as death. The other patients were divided into control group and observation group according to different nursing methods. Among them, the control group adopted nutrition nursing, and the observation group implemented cluster nursing on this basis. The differences of liver function, anxiety and depression score, gastrointestinal recovery, nutritional status, and sleep quality were compared between the 2 groups before and after nursing. After nursing, the total bilirubin, albumin, and aspartate aminotransferase of the observation group were significantly higher than those of the control group (P < .05). The nursing staff used Self-Rating Anxiety Scale and Self-Rating Depression Scale of the observation group, which were slightly lower than those of the control group. The difference was statistically significant after testing (P < .05). After nursing, the observation group's upper arm circumference, brachial tri-scalp fold thickness, and hemoglobin were better than those of the control group. Statistics showed that the difference was statistically significant (P < .05). The depth of sleep, time to fall asleep, number of awakenings, time to fall asleep after awakening, overall sleep quality, and intensive care unit environmental noise intensity in the Richards-Campbell Sleep Questionnaire sleep scale after nursing in the 2 groups were significantly higher than those before nursing, and the scores of the observation group were significantly lower than those in the observation group. In the control group, this difference was statistically significant (P < .05). Nutritional nursing combined with clustered nursing can effectively promote the recovery of gastrointestinal function in patients with severe liver failure.

Observation of the effect of single dose intravenous infusion of tranexamic acid on white blood cell, erythrocyte sedimentation rate and C-reactive protein after double segmental posterior lumbar interbody fusion

To observe the safety and effectiveness of single dose intravenous infusion of tranexamic acid (TXA) in dual level posterior lumbar interbody fusion (PLIF), and to explore the changes and trends in perioperative white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Between October 2020 and September 2022, 46 patients with lumbar degenerative disease were treated with dual level PLIF, including 18 males and 28 females, with an average age of (60.24±10.68) years old, from 34 to 80 years old. They were divided into observation group and control group according to different treatment methods. There were 28 patients in the observation group, including 12 males and 16 females, with an average age of (61.04 ± 9.03) years old. There were 3 cases with lumbar disc herniation (LDH), lumbar spinal stenosis (LSS) 18 cases, lumbar spondylolisthesis (LS) 7 cases. TXA (1 g/100 ml) was administered intravenously 15 min before skin incision after general anesthesia. The control group consisted of 18 patients, including 6 males and 12 females, with an average age of (59.00±13.04) years old. There were 5 cases with LDH, LSS 9 cases, LS 4 cases, and TXA was not used. The operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative deep vein thrombosis (DVT), postoperative hospital stay, postoperative activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), platelet (PLT), red blood cell (RBC), hemoglobin (HB), hematocrit (HCT), the first day, the fourth day, the seventh day and the last tested after operation WBC, ESR and CRP were recorded. The postoperative wounds of the patients healed well and there was no DVT. 46 patients were followed up from 3 to 6 months. The intraoperative blood loss was 400.0 (300.0, 500.0) ml and the postoperative drainage was 260.0 (220.0, 450.0) ml in the observation group, which were lower than the control group[600.0(400.0, 1000.0) ml, 395.0 (300.0, 450.0) ml], P<0.05. There was no significant difference between the two groups in operation time, postoperative hospital stay, postoperative APTT, PT, TT, FIB, PLT, RBC, HB, HCT, and postoperative WBC, ESR and CRP at different times (P>0.05). Single dose intravenous infusion of TXA can reduce the blood loss of bi-segmental PLIF, and has no significant effect on WBC, ESR and CRP after operation.

Early clinical efficacy study on the efficacy of a three-stage conservative Chinese medicine external treatment for acute lateral ankle ligament injuries

To evaluate the clinical effect of a new three-phase Chinese medicine (CM) external treatment for acute lateral ankle ligament injuries. From July to December 2023, 64 patients with acute lateral ankle ligament injuries were randomly assigned to receive either the new three-phase CM external treatment combined with the POLICE(protect, optimal loading, ice, compression, elevation) treatment (observation group) or the POLICE treatment (control group), with 32 cases in each group. The observation group consisted of 17 males and 15 females, with an average age of(30.59±3.10) years old ranging from 25 to 36 years old, while the control group included 14 males and 18 females, with an average age of(30.03±3.19) years old ranging from 24 to 37 years old. Visual analogue scale (VAS) evaluation and Figure of 8 measurement were used to evaluate the degree of ankle joint pain and swelling of the subjects at the initial enrollment and after 1 week and sixth weeks of treatment. At the same time, the American Orthopaedic Foot and Ankle Society (AOFAS) and Karlsson Ankle Function Score System were used to evaluate the improvement of ankle joint function in patients at all stages. MRI imaging was employed to observe the degree of biological healing of the anterior talofibular ligament, with the signal to noise ratio(SNR) indicating the level of healing. A lower SNR suggests better ligament healing, as it represents lower water content in the ligament. All patients completed a 6-week follow-up. There was no significant difference in VAS, AOFAS score and Karlsson score between the two groups before treatment (P>0.05). After 1 week and 6 weeks of treatment, the VAS, AOFAS score and Karlsson score of the two groups were significantly improved (P<0.05). After 1 week of treatment, the VAS score of the observation group (3.21±0.87) was lower than that of the control group (4.21±1.50), and the difference was statistically significant (P<0.05). After 1 weeks of treatment, the AOFAS and Karlsson scores [(50.84±4.70) points, (49.97±4.00) points] of the observation group were higher than those [(46.91±5.56) points, (46.66±5.36) points]of the control group (P<0.05). MRI images showed that after 6 weeks of treatment, the SNR value of the observation group was significantly lower than that of the control group, and the difference was statistically significant(SNR of the observation group was 75.25±16.59, the contral gruop was 85.81±15.55), (P<0.05). Compared with the control group, the new three-phase CM external treatment is significantly effective in reducing pain and swelling, enhancing ligament repair quality, and promoting functional recovery of the ankle joint in patients with acute lateral malleolar ligament injuries.

Risk factors affecting cervical spondylotic myelopathy complicated with traumatic central cord syndrome and the efficacy of different treatment options

ObjectiveTo analyze the influencing factors and treatment options of cervical spondylotic myelopathy (CSM) complicated with traumatic central cord syndrome (TCCS).MethodsA total of 243 patients with CSM admitted to our hospital from January 2021 to September 2022 were retrospectively analyzed, and then divided into the control group (n = 152) and the observation group (n = 91) according to the presence or absence of concurrent TCCS. The clinical data and imaging data of the two groups were compared, and multivariate logistic regression was used to analyze the influencing factors of CSM complicated with TCCS. Patients in the observation group were further divided into the zero notch anterior cervical interbody fusion device (Zero-P) group (n = 45) and the cervical spine locking plate (CSLP) group (n = 46) according to the treatment mode, and the perioperative indexes of the two groups were compared. The treatment effects were evaluated by the American Spinal Injury Association (ASIA) and the Japanese Orthopedic Association (JOA) before surgery, 1 week after surgery and 6 months after surgery. The height of intervertebral space and the cervical lordosis angle were measured.ResultsMultivariate logistic regression analysis showed that the injury mechanism (hyperextension injury), hand muscle weakness, cervical instability, age, degree of cervical spinal stenosis, degree of cervical spinal cord compression, and changes in intramedullary high signal were the risk factors, while the type of compression (soft), ASIA score and JOA score were the protective factor for CSM complicated with TCCS (P < 0.05). Patients in Zero-P group had much shorter operation time and hospitalization time than these in CSLP group (P < 0.05). The cervical lordosis angle and intervertebral space height at 1 week and 6 months after operation in the two groups were both largely higher than these before operation, and the cervical lordosis angle and intervertebral space height in the Zero-P group were significantly higher than these in the CSLP group one week after surgery (P < 0.05). The ASIA score and JOA score were obviously increased in the two groups 1 week and 6 months after surgery, and the ASIA score and JOA score in the Zero-P group were significantly higher than these in the CSLP group at 1 week after surgery (P < 0.05).ConclusionThe mechanism of TCCS in CSM is still controversial, which it is generally believed to be caused by cervical hyperextension injury. The clinical symptoms are diverse, and the treatment methods are also different. This study shows that the mechanism of injury, type of compression, hand muscle weakness, cervical instability, age, cervical stenosis compression, and intramedullary high signal changes are all risk factors for CSM complicated with TCCS. Early identification of risk factors and targeted interventions can effectively reduce the complicated rate of TCCS. Zero-P and CSLP surgical fixation have good efficacy in the treatment of TCCS, and there is little difference in efficacy between the two. However, Zero-P fixation surgery has the advantages of short operation time and fast postoperative recovery.

Continuous positive airway pressure in delivery room in extremely preterm infants: A single‐center retrospective study in China

AbstractTo assess the beneficial effects of delivery room continuous positive airway pressure (DRCPAP) in extremely preterm infants, a single‐center retrospective study was performed at the Women and Children's Hospital of Chongqing Medical University in China. Infants born between January 2016 and December 2018 were regarded as the control group, and those born between January 2019 and August 2022 were considered as the observation group (DRCPAP group). The primary outcome was tracheal intubation within 72 h after birth. Six hundred and seven patients were included in the study (control: 232; DRCPAP: 375). Compared with the control group, DRCPAP reduced the intubation rate (56.8% vs. 62.9%, OR 0.57, 95% CI 0.34–0.96, p = 0.035), including &lt;28 weeks gestational age (GA) subgroup (61.5% vs. 84.7%, OR 0.12, 95% CI 0.02–0.78, p = 0.027). One‐to‐one propensity score matching (195:195) was used to match the baseline characteristics of patients in DRCPAP and control group. After matching, no significant differences were observed in intubation rate within 72 h between the two groups (20.5% [40 of 195] vs. 22.1% [43 of 195]; p = 0.711). Whether DRCPAP can reduce intubation rate within 72 h requires further investigation.

Radiosurgery versus observation for brainstem cavernous malformations: a 5-year multicentre cohort study.

The role of radiosurgery in preventing haemorrhage in brainstem cavernous malformations remains a subject of debate. This study aims to evaluate whether radiosurgery provides a protective benefit against haemorrhage in these patients. This multicentre, prospective observational study was conducted in 17 centres and enrolled eligible patients with brainstem cavernous malformations consecutively. Data collected included clinical baseline information, radiosurgery planning details, periodic follow-up evaluations, and any adverse radiation effects. The primary outcome of the study was the incidence of first prospective haemorrhage, while the secondary outcome was the development of new or worsening neurological dysfunctions. The impact of radiosurgery was assessed using multivariate Cox regression analysis. From March 2016 to August 2018, the study enrolled 377 patients: 280 in the observation group receiving standard care alone and 97 in the radiosurgery group receiving both radiosurgery and standard care. The overall cohort consisted of 173 females (45.9%) with a mean age of 40.5 years (range, 18-68 years), and there were no significant differences in baseline characteristics between the two groups. After a median follow-up period of 70 months, haemorrhage occurred in 25.0% (n = 70) of patients in the observation group and 10.3% (n = 10) of patients in the radiosurgery group. Multivariate Cox regression analysis identified radiosurgery as an independent protective factor against haemorrhage (hazard ratio 0.379, 95% confidence interval 0.195-0.738, P = 0.004). Following 1:2 propensity score matching, the incidence of prospective haemorrhage were 24.9% (45/181) in the observation group compared to 10.3% (10/97) in the radiosurgery group (hazard ratio 0.379, 95% confidence interval 0.190-0.755, P = 0.006). Adverse radiation effects were observed in 12 patients (12.4%), with none were permanent. Additionally, new or worsening neurological dysfunctions were significantly more common in the observation group (28.9%) compared to the radiosurgery group (16.5%) (P = 0.016). These results suggest that radiosurgery is associated with a low rate of haemorrhage in patients with brainstem cavernous malformations and could provide a benefit in selected patients. However, further research is required to confirm these findings.

Analysis of Clinical Application of Minimally Invasive Technique in Alveolar Surgery

Objective To explore the clinical effect of minimally invasive techniques in the treatment of alveolar surgery. Methods 80 patients who underwent dental surgery from March 2023 to March 2024 were selected as study samples and randomly divided into two groups. The control group (40 cases) underwent the traditional extraction method, and the observation group (40 cases) underwent the minimally invasive technique. The integrity rate of tooth extraction, pain rate, postoperative infection rate and treatment effect were compared between the two groups. Results The integrity rate of tooth extraction, pain rate and postoperative infection rate in observation group were lower than those in control group (P &lt; 0.05). The therapeutic effect of observation group was significantly higher than that of control group (P &lt; 0.05). Conclusion Minimally invasive technique has a significant effect in the treatment of alveolar surgery, which can reduce the degree of pain and the probability of infection and improve the integrity of the alveolar.

Temporal variations of N and P losses via surface runoff from Chinese farmland after fertilisation

The loss of nitrogen (N) and phosphorus (P) via surface runoff induced by fertilisation leads to water pollution and aggravates water scarcity. Studies estimating N and P losses from farmland have focused on the efficacy of agricultural management actions at reducing the amount of N and P lost. However, a gap remains in understanding the dynamics of N and P losses from farmland, especially differences among types of farmland, crop and fertiliser. Thus, the temporal variations of N and P losses via surface runoff from farmland induced by fertilisation were estimated using 5530 groups of paired observations collected in China. The results showed that N and P losses via surface runoff from paddy fields associated with fertilisation were greater than losses from upland fields. However, after > 90 days post-fertilisation, the effects of fertilisation on N and P loss from paddy fields were non-significant, while the effects of fertilisation on N and P losses from upland fields remained significant. Organic fertilisation decreased N losses from upland and paddy fields, but at more than 60 days post-fertilisation, N and P losses from upland fields were greater with organic than chemical or combined fertilisation. Increasing the fertilisation rate led to higher N and P losses from upland and paddy fields and extended the occurrence time of N and P loss from paddy fields. Overall, this study demonstrates the dynamic processes associated with fertilisation underlying N and P losses from farmland via surface runoff.

Problems of Good Governance in Managing Indonesia’s Borderland: The Case of Entikong Subdistrict

The present study explores the good governance processes of border management in Entikong Subdistrict. The Entikong Subdistrict in West Kalimantan is a priority district that receives special attention from Indonesian central and local governments. The Entikong border post started operating in 1989, making it the first land border in Indonesia. Nevertheless, despite its aged history and many development efforts within the area, the economic growth and welfare of the border community remained stagnant. The data for this article were collected through a field work in Entikong for four months in 2022 in which we conducted observation, interviews, and focus group discussion with local residents and government officers. This study reveals that good governance became the focal issue explaining Entikong’s lack of development by providing two problems in the border development at Entikong: 1) the government’s inconsistency on the road widening project and 2) the complexity of governance and bureaucracy. This paper further elaborates on the essence of locality in good governance practices while simultaneously addressing the authority division problems and communication towards the demands of the local community. This study argues that better public communication patterns should be implemented to avoid misunderstandings within the community and increase the participation of local citizens, government, and civil society in the development process of the border area.

Creating Lasting Conditions for Meaningful Recess Reform: A 5-School Exploration.

When well implemented, recess is a critical part of the school day for children's healthy development. We explored the implementation of a recess improvement process in 5 elementary schools across 3 states. We conducted a mixed-methods implementation study in which we visited each school 3 times over 1 school year, collecting observational, interview, survey, and focus group data. Qualitative data were coded thematically and analyzed across schools. Quantitative data were tabulated and aggregated over time and across schools. We observed improvements in aspects of recess quality at each school, with three schools demonstrating the most progress. Quantitative data showed null effects in aggregate; however one school demonstrated significant improvements. Four criteria contributed to the quality and sustainability of recess reform: staff engagement, integration with other programs, student leadership, and recess communications. Program implementation research often refers to "buy-in" as a key ingredient to successful adoption. We provide a tool that helps to operationalize buy-in in the recess context. Changing the recess environment requires individual and institutional commitment to valuing recess as an important learning environment. School administrators must lead the change process and create institutional infrastructure to support success.

Short-Term Efficacy of Transumbilical Single-Incision Versus Conventional Laparoscopic Cholecystectomy: A Retrospective Cohort Study.

Background: With the rising demand for minimally invasive and cosmetically appealing surgeries, transumbilical single-incision laparoscopic cholecystectomy (SILC) has been increasingly adopted, albeit in a limited number of medical centers. Our team has successfully executed transumbilical SILC for benign gallbladder diseases. This study retrospectively analyzed and compared the efficacy of transumbilical SILC with that of conventional laparoscopic cholecystectomy (CLC). Methods: We analyzed data from 358 cases of laparoscopic cholecystectomy performed at Shanghai East Hospital of Tongji University between January 2021 and October 2023. Of these, 186 cases underwent SILC (observation group), while 172 cases underwent CLC (control group). We compared patient demographics, perioperative outcomes, and satisfaction with incision scars. Primary outcomes included surgical efficacy and safety, whereas secondary outcomes encompassed postoperative hospitalization duration, pain levels, hospital costs, and scar satisfaction. Results: No significant differences were observed in patient demographics between the two groups. Both the SILC and CLC groups exhibited similar operative times (39.56 ± 14.55 minutes versus 41.82 ± 16.13 minutes, P = .164) and intraoperative blood loss (11.34 ± 3.90 mL versus 11.28 ± 3.87 mL, P = .885). The single-incision approach led to earlier postoperative bowel function recovery (22.03 ± 3.60 hours versus 24.17 ± 3.22 hours, P < .01), lower 24-hour postoperative pain scores (2.06 ± 0.84 versus 2.35 ± 0.72, P < .01), shorter postoperative hospital stays (2.88 ± 0.86 days versus 3.33 ± 0.96 days, P < .01), comparable hospitalization costs (3411.67 ± 790.86$ versus 3494.50 ± 558.76$, P = .257), and better Scar Cosmesis Assessment and Rating scores (1.78 ± 0.70 versus 2.17 ± 0.89, P < .01). Patient satisfaction was higher with the single-incision technique (8.52 ± 0.79 versus 7.80 ± 0.75, P < .01). Both groups experienced one case of incision infection (SILC 0.54%, CLC 0.58%), and there was one case of postoperative bile leakage in the CLC group (0.58%). However, the difference in complications was not statistically significant (P > .05). Conclusion: Transumbilical SILC demonstrates safe and effective near-term efficacy, offering benefits such as reduced postoperative pain and improved cosmetic outcomes, which support its clinical adoption.

Comparison of the analgesic effects of infraspinatus-teres minor interfascial block and interscalene block under ultrasound guidance in patients undergoing arthroscopic shoulder surgery

Objective: To compare the postoperative analgesic efficacy of ultrasound-guided infraspinatus-teres minor interfascial block and interscalene block in shoulder arthroscopic surgery. Methods: A total of 74 patients undergoing shoulder arthroscopic surgery at the Affiliated Hospital of Jiaxing University from December 2023 to February 2024 were prospectively included, whose age ranged from 18 to 80 years and the American Society of Anesthesiologists (ASA) grade were Ⅰ-Ⅲ. Patients were divided into two groups using block randomization: infraspinatus-teres minor interfascial block group (observation group) and interscalene block group (control group), with 37 cases in each group. In the anesthesia preparation room, all patients received nerve blocks under ultrasound guidance with 20 ml of 0.375% ropivacaine. Patient-controlled intravenous analgesia (PCIA) was administered to all patients following surgery. The primary outcome was the area under the curve (AUC) of the numeric rating scale (NRS) for pain within 24 hours postoperatively. Secondary outcome measures included the highest NRS score within 48 hours postoperatively, the amount of sufentanil used via PCIA within 48 hours postoperatively, the incidence of rescue analgesia and rebound pain, QoR-40 scores, and the rate of postoperative nausea and vomiting within 24 hours. The non-inferiority margin for the AUC of NRS scores between the two types of regional nerve blocks was set at "2.6". Results: A total of 35 patients were included in the observation group [17 males, 18 females, aged (58.1±9.1) years], and 36 patients were included in the control group [12 males, 24 females, aged (57.0±9.8) years]. The AUC of the NRS scores at rest within 24 hours post-operation was 51.7±10.9 in the observation group and 62.6±13.6 in the control group. The difference in AUC between the two groups was -10.9 (95%CI:-16.8--5.1), with the upper limit of the 95%CI falling below the predefined non-inferiority margin of "2.6" (non-inferiority P<0.001). The highest NRS score [M (Q1, Q3)] within 48 hours post-surgery was 3 (3, 4) in the control group, which was significantly higher than the observation group's score of 2 (2, 3) (P<0.001). During the postoperative period of 0-12 hours, the observation group received a median dose of 12 (10, 14) μg of sufentanil, which was significantly higher than the control group's dose of 8 (6, 10) μg (P<0.001). During the postoperative period of 12-24 hours, the observation group received a median dose of 8 (8, 10) μg of sufentanil, which was significantly lower than the control group's median dose of 12 (10, 14) μg (P<0.001). During the postoperative period of 24-48 hours, there was no statistically significant difference in the dose of sufentanil between the two groups of patients (P=0.548). In the observation group, the incidence of rescue analgesia within 48 hours postoperatively was 0 (0/35), which was lower than that of the control group at 22.2% (8/36) (P=0.010). The occurrence of rebound pain in the observation group was 0 (0/35), and the control group was 11.1% (4/36), no statistically significant difference was found between two groups (P=0.130). In the observation group, the QoR-40 score within 24 hours post-operation was 180.2±3.2, which was higher than the control group's score of 175.8±4.7 (P<0.001). There was no statistically significant difference in the incidence of postoperative nausea and vomiting within 24 hours between the two groups (P=0.372). Conclusion: Ultrasound-guided infraspinatus-teres minor interfascial block demonstrates a comparable analgesic effect to interscalene block in shoulder arthroscopic surgery within the first 24 hours postoperatively.

Incisional Negative Pressure Wound Therapy Versus Primary Wound Suturing after Intestinal Ostomy Closure: A Systematic Review and Meta-Analysis.

Objective: Wound infection after intestinal ostomy closure is a very common postoperative complication. An alternative to primary wound suturing by single sutures or purse string sutures (PSS) is applying incisional negative pressure wound therapy (iNPWT). The aim of the following systematic review and meta-analysis was to assess and compare clinical outcomes in patients after PSS and iNPWT use. Approach: The aim of the study was to find relevant clinical data comparing outcomes of iNPWT and primary wound closure after intestinal ostomy closure. The search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases and took place up to November 12, 2022. The authors did not use date or language filters. Statistical analysis was performed using Review Manager 5.4 (The Cochrane Collaboration, 2020, London, UK). The authors conducted a meta-analysis of the following four parameters: wound healing time (WHT), surgical site infections (SSIs), complications, and length of hospital stay (LOS). Odds ratios (OR) and inverse variance (IV) were generated with 95% confidence intervals (CI). The meta-analysis was registered in the International Prospective Register of Systematic Reviews database under registration number CRD42023391640. Results: The analysis revealed that the iNPWT group and the control group did not differ significantly with regard to the WHT parameter (Z = 2,73; p = 0.006; χ2 = 0.37, df = 1, p = 0.54, I2 = 0%). Meta-analysis of SSI incidence revealed a significant difference favoring the iNPWT group over the observational group (OR = 0.42; 95% CI = 0.25-0.72; p = 0.002; I2 = 14%). Patients included in the iNPWT group had a significantly lower pooled incidence of overall complications than the observational group (OR = 0.52; 95% CI = 0.35-0.77; p = 0.001, I2 = 71%). Subgroup analysis limited to randomized studies also presented significant differences favoring the iNPWT group over the observational group (OR = 0.27; 95% CI = 0.14-0.52; p < 0.001, I2 = 67%). Our analysis showed that LOS did not differ significantly between the groups treated with and without iNPWT (IV = 0.19; 95% CI = -0.66 -1,04; p = 0.76, I2 = 0%). In addition, subgroup analysis of randomized studies also did not present a significant difference (IV = 0.25; 95% CI = -0.80 -1,30; p = 0.33, I2 = 10%). Innovation: This study shows that the use of iNPWT can reduce the risk of SSIs with other complications, such as wound hematomas, wound seromas, wound dehiscence, fistulas, and ileus, in patients undergoing intestinal ostomy closure without extended hospital stay. Conclusions: Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate of the most common complications after ostomy closure.