Objective  To compare the predictive value of innovative and traditional adiposity indices for metabolic syndrome (MS) risk in the Yi people of Yunnan Province.  Methods  A total of 508 residents from 3 Yi settlements in Yunnan Province were selected by random cluster sampling during November 2018 to September 2023. The traditional adipose indexes of waist circumference, hip circumference, BMI, waist-to-height ratio (WHtR) and related laboratory indexes were collected, and the innovative adipose indexes of China visceral adipose index (CVAI), visceral adipose index (VAI) and lipid accumulation product (LAP) were calculated. Statistical analysis was performed.  Results  The prevalence of metabolic syndrome was 20.01% (102/508) in the in the Yi population of Yunnan Province. Spearman correlation analysis showed that MS was significantly correlated with all adiposity indices. ROC curve analysis showed that the area under the curve of each adipose indexes was greater than 0.7, and the AUC of CVAI was the largest (AUC=0.872). The optimal cut-off values of CVAI, VAI and LAP were 120.20, 2.02 and 56.36, respectively. In different gender and body mass subgroups, the predictive value of the innovative adipose indexes is better than that of the traditional indices. According to the optimal cut-off value of the ROC curve, the groups were defined as C0 (CVAI < 120.20), C1 (CVAI≥120.20), V0 (VAI < 2.02), V1 (VAI≥2.02), L0 (LAP < 56.36) and L1 (LAP≥56.36), Multivariate logistic regression analysis showed that the risk of MS was 8.484 times higher in group C1 than in group C0. The risk of MS was 13.602 times higher in group V1 than in group V0. The risk of MS was 4.916 times higher in group C1 than in group C0.  Conclusion  The innovative adipose index has certain advantages in predicting MS in the Yi population of Yunnan Province, but the traditional index is also valuable when the relevant lipid index is missing. When the innovative adipose indexes exceed the optimal cut-off value, the risk of MS is significantly increased.

  Objective  To summarize the experience in rehabilitation management in the first case of adult living donor liver transplantation in Anhui Province.  Methods  The doctor-nurse integrated group was established in the Department of Organ Transplantation, Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University in December 2021. The doctor-nurse integrated management consisted of precise care in three courses: preoperative evaluation stage, perioperative period and domestic management period of both of the liver transplant donor and recipient. During the preoperative evaluation period of transplantation, comprehensive assessment and intervention of medical care integration were carried out from three aspects: anatomy, physiology and social psychology. The living donor liver transplantation must be especially approved from the senior ethics committee. A precise overall evaluation of both the donor and the recipient is a cornerstone in a successful living donor liver transplantation. In addition to routine perioperative care during the perioperative period, a good recovery of both the donor and the recipient is dependent on the following five aspects: adequate preoperative preparation, refined care in immunosuppressive drugs management, monitoring of transplanted organ function, protective isolation in case of infection prevention, and optimization of rapid recovery management strategies. During the domestic care course, various nursing interventions were used to improve the self-efficacy level of the recipients, to encourage patients to adopt healthy behaviors, to optimize the postoperative examination process and to track the drug compliance by monitoring the blood drug concentration, counting tablet and collecting questionnaire survey.  Results  Both donor and recipient underwent successful operations. The donor recovered well and was discharged from the hospital 11 day after operation and the recipient was discharged on the 18th day with satisfied recovery. The blood biomarkers of both the donor and the recipient indicated sufficient liver function. The plasma concentration of immunosuppressants was maintained at an ideal level, and the remnant liver volume of both the donor and the recipient was appropriate. The follow-up was conducted intensively during the domestic care course. It turned out that both the donor and the recipient showed satisfied recovery 8 months after the operation.  Conclusion  Adult living donor liver transplantation requires close cooperation of the medical team, rigorous attitude, high-quality management, and precise treatment and nursing measures, so as to obtain a satisfactory prognosis for both the donor and the recipient.

  Objective  To explore the risk factors of enteral feeding intolerance (EFI) in sepsis patients and to understand the occurrence of EFI in sepsis patients. To construct a risk prediction model for the occurrence of EFI in sepsis patients to facilitate the screening of high-risk groups to prevent and control the occurrence of EFI.  Methods  Convenience sampling method was used to select sepsis patients admitted to the Department of Critical Care Medicine of a tertiary-level hospital in Xinjiang who underwent enteral nutrition therapy from January 2022 to June 2023 as study subjects and were divided into the feeding tolerance group and feeding intolerance group by whether or not EFI occurred in the patients, and a one-way analysis was carried out on the patients ' general, clinical, and feeding intolerance-related data, and LASSO regression was applied to solve the covariance problem among variables, then the variables in the results of LASSO regression analysis were included in logistic regression analysis to derive the risk factors for EFI in patients with sepsis, on the basis of which we constructed a prediction model for the risk of EFI in patients with sepsis, and plotted a Nomogram, ROC curve, decision curve analysis, and calibration curve to evaluate and validate the diagnostic efficacy of the prediction model.  Results  A total of 199 sepsis patients with enteral nutrition therapy were included, including 93 cases in the intolerant group and 106 cases in the tolerant group, and the incidence rate of EFI was 46.7%. Multifactorial analysis showed that sequential organ failure assessment (SOFA) score, nutritional risk screening (NRS-2002) score, analgesics, and ICU length of stay were independent risk factors for the occurrence of EFI in patients with sepsis. The area under the ROC curve was 0.885 (95% CI: 0.833-0.933), and the maximal Youden index was 0.689, with a sensitivity of 0.849, and a specificity of 0.839.  Conclusion  SOFA score, NRS-2002 score, analgesics, and ICU length of stay are risk factors for EFI in septic patients. The risk prediction model constructed in this study based on this was validated and found to be a more accurate predictor of the risk of EFI in patients with sepsis, which can help clinical healthcare professionals provide scientific and individualized enteral nutrition therapy to patients.

  Objective  This study retrospectively reanalyzed the reflux parameters of patients with gastroesophageal reflux disease (GERD) detected through esophageal pH and impedance pH monitoring, following the "Lyon Consensus". The DeMeester scores (DMS) were compared to the acid exposure time (AET).  Methods  This study included a total of 1 023 GERD patients who underwent 24-hour esophageal pH monitoring or impedance pH monitoring at the Gastrointestinal Dynamics Center of Peking Union Medical College Hospital from January 2008 to December 2022. The reflux parameters were reanalyzed and compared using DMS and AET, respectively.  Results  (1) According to the "Lyon Consensus", AET demonstrates 94.7% sensitivity and 99.0% specificity, while DMS shows 98.1% sensitivity and 97.2% specificity. DMS exhibits higher sensitivity than AET, whereas AET has greater specificity than DMS. The monitoring results of the both methods are highly consistent (P < 0.05). (2) Among the 105 patients with AET ranging from 4% to 6%, they were divided into DMS (+) and DMS (-) groups. Significant differences were observed between the two groups in terms of the total number of reflux episodes, number of reflux episodes lasting≥5 min, %supine time esophageal pH < 4, and longest reflux episode (in minutes). These findings suggest that these parameters should be considered and analyzed in addition to AET. (3) It is worth noting that more than 50% GERD patients with AET ranging from 4% to 6% still cannot determine the presence or absence of pathological reflux.  Conclusion  Both the diagnostic standards of AET and DMS provide robust supporting evidence for esophageal acid exposure. AET exhibits lower sensitivity but higher specificity compared to DMS. To enhance the sensitivity of AET, considering the hypothesis of AET>4% demonstrates esophageal acid exposure might be beneficial.

Digital therapeutics, as an emerging effective and safe intervention driven by high-quality software programs, are increasingly being used in primary care based clinical practice. Cognitive-behavioral therapy (CBT) is the most widely used classical approach in psychotherapy and is also a core technology in many digital therapeutics products. CBT interventions are usually limited by the lack of treatment space and professionals, which makes it impossible to reach out to a wider target group of patients. With the help of digital therapeutics, CBT technology can be integrated into the corresponding design module to break through these limitations. At present, CBT-digital therapeutics products are mainly used in the field of primary chronic disease prevention and treatment in the field of lifestyle intervention and patient-centered care, and there is still a large development potential for their application in health monitoring and prevention of common chronic diseases, disease treatment and optimization of drug treatment effects. As an important support to lead the efficient promotion of the quality of primary care services and meet the development of active health technology, CBT-digital therapeutics have ushered in key development opportunities driven by the strong support of the policy environment, the comprehensive technological innovation empowered by emerging technologies, and the increased willingness of patients with chronic diseases to manage their health. At the same time, there are still some key points that need to be broken through and improved in the future of CBT-digital therapeutics. In the future, it is necessary to pay attention to the accumulation of clinical data that meets the needs of supervision, and use algorithm technology to further accurately locate the personalized needs of patients based on patients ' chronic disease data, so as to broaden the indications for chronic disease management of CBT-digital therapeutics. At the same time, it is necessary to further improve the regulatory regulations related to digital therapeutics, formulate an approval system suitable for digital therapeutics products, and improve industry standards in terms of data security, privacy protection, and medical insurance payment policies.

  Objective  This study aims to explorea method for primary healthcare units to assess exercise endurance impairment in patients with chronic obstructive pulmonary disease (COPD) using the DOSE index as the core indicator. Additionally, the study aims to determine the critical value of this indicator for predicting exercise endurance impairment in patients with COPD.  Methods  A total of 117 stable COPD patients who were monitored at the China-Japan Friendship Hospital from September 2019 to April 2022 were included in the retrospective analysis. Patients with a six-minute walk distance (6MWD) of less than 350 m were determined to be exercise tolerance. Information on lung function, the modified medical research council (mMRC), smoking status, and acute exacerbations in the previous year was calculate the DOSE index for each patient. Lung function, 6MWD, mMRC scores, and DOSE index were compared between the two groups divided based on 6MWD. The relationship between 6MWD and the DOSE index was investigated using Spearman's correlation analysis; Finally, the effectiveness of the DOSE index in assessing impaired exercise tolerance in COPD patients was analyzed using a receiver operating characteristic (ROC) Curve.  Results  A total of 117 patients with stable COPD were included in this study. The mean 6MWD was (416.94±117.16) m and the mean DOSE index was 3(1, 5) points. Among the participants, 29 had a 6MWD < 350 m, while 88 had a 6MWD ≥350 m. Significant differences were observed between these two groups in terms of age, FVC%pred, FEV₁%pred, 6MWD, mMRC score, and DOSE index. Notably, there was a strong inverse relationship between the DOSE index and 6MWD (r=-0.456, P < 0.001). Physicians should be particularly vigilant about impaired exercise tolerance in COPD patients.  Conclusion  The DOSE index, with a predictive threshold of 5 points, exhibits a strong and negative correlation with 6MWD, making it a valuable tool in assessing impaired exercise tolerance among COPD patients. Its simplicity and ease of administration make the DOSE index suitable for implementation in primary healthcare settings.