Optimal evidence analysis for the nursing management of limb spasm in patients with spinal cord injury / 中华创伤杂志

Objective:To explore the optimal evidence for the nursing management of limb spasm in patients with spinal cord injury.Methods:Based on the "6S" evidence model, the databases including CNKI, Wanfang, PubMed and Cochrane Library, the guideline websites such as the National Guideline Clearinghouse, Guidelines International Network and Registered Nurses′ Association of Ontario, and the websites of professional associations such as the Royal College of Physicians, American Spinal Injury Association and Canadian Spine Association were systematically searched. Search period of each database was set from the year of inception until July 2022. Two investigators independently screened the literatures related to the management of limb spasm in patients with spinal cord injury, and conducted quality evaluation and evidence recommendation level evaluation.Results:Totally 17 literatures consisting of 6 guidelines, 3 expert consensuses, 5 systematic reviews, 2 evidence summaries, and 1 clinical decision were included. Moreover, 30 pieces of evidence were summarized from 3 aspects, including evaluation and identification, drug therapy (chemical denervation, and oral medication), rehabilitation training (hydrotherapy, electrical stimulation, magnetic stimulation, vibration therapy, heat and cold therapy, body position, and exercise therapy).Conclusion:Nursing staff can set up a multidisciplinary team according to the clinical environment and take into consideration of the characteristics of spinal cord injury patients to provide personalized interventions involving evaluation and identification, drug therapy, rehabilitation training, etc., so as to alleviate the degree of limb spasm.

FMO3-TMAO axis modulates the clinical outcome in chronic heart-failure patients with reduced ejection fraction: evidence from an Asian population / 医学前沿

The association among plasma trimethylamine-N-oxide (TMAO), FMO3 polymorphisms, and chronic heart failure (CHF) remains to be elucidated. TMAO is a microbiota-dependent metabolite from dietary choline and carnitine. A prospective study was performed including 955 consecutively diagnosed CHF patients with reduced ejection fraction, with the longest follow-up of 7 years. The concentrations of plasma TMAO and its precursors, namely, choline and carnitine, were determined by liquid chromatography-mass spectrometry, and the FMO3 E158K polymorphisms (rs2266782) were genotyped. The top tertile of plasma TMAO was associated with a significant increment in hazard ratio (HR) for the composite outcome of cardiovascular death or heart transplantation (HR = 1.47, 95% CI = 1.13-1.91, P = 0.004) compared with the lowest tertile. After adjustments of the potential confounders, higher TMAO could still be used to predict the risk of the primary endpoint (adjusted HR = 1.33, 95% CI = 1.01-1.74, P = 0.039). This result was also obtained after further adjustment for carnitine (adjusted HR = 1.33, 95% CI = 1.01-1.74, P = 0.039). The FMO3 rs2266782 polymorphism was associated with the plasma TMAO concentrations in our cohort, and lower TMAO levels were found in the AA-genotype. Thus, higher plasma TMAO levels indicated increased risk of the composite outcome of cardiovascular death or heart transplantation independent of potential confounders, and the FMO3 AA-genotype in rs2266782 was related to lower plasma TMAO levels.

Multicenter study on the effect of early screening skills training for autism spectrum disorders in primary care hospitals in Chengdu / 四川精神卫生

ObjectiveTo investigate effect of conducting training of autism spectrum disorder （ASD） early screening skill on improving the ability to early identify ASD of medical staffs in primary care hospitals. MethodsIn September 2021， the training of ASD early screening skills was carried out for medical staffs from 20 primary care hospitals in Chengdu. After training， the training effect was evaluated. The numbers of referrals from primary care hospitals to superior hospitals， confirmed ASD as well as their average diagnostic age of children with ASD before and after training were used as evaluation indicators. ResultsAfter training， the number of children with suspected ASD referred by primary care hospitals was more than that before training ［（16.65±11.60） vs. （3.40±2.23）， t=5.431， P<0.01］， the number of children diagnosed with ASD was more than that before training［（6.85±4.93） vs. （2.45±1.67）， t=4.171， P<0.01］， and the differences were statistically significant. As for the diagnosed age of ASD children， after training， the average age was lower than that before training ［（34.95±11.67） vs. （42.2±14.64）， t=-2.553， P=0.019］. ConclusionTraining of ASD early screening skills for medical staffs in primary care hospitals may help to improve their ability to early screening ASD children.

Occurrence of injuries among left-behind children from 27 poor rural areas in 12 provinces of China, 2016 / 中华流行病学杂志

Objective@#To understand the injuries among 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, 2016.@*Methods@#Data were collected from the survey of 'Health Service Needs Assessment’ (HSNA) program on left-behind children, from poor rural areas in the middle and western parts of China. Factors including causes, types, locations, related activities, ways of treatment and outcomes among left-behind children with injuries in 2016, were described and analyzed by gender and age groups.@*Results@#In 2016, per-person and person-time incidence rates of injuries were 8.88% and 11.21%, among the 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, both higher in boys, than in girls. Most injuries were unintentional with its proportion higher in older children. The main types of injuries were seen as falls, blunt and sharp injuries, with burns and animal injuries more common in younger children. Injuries among left-behind children mainly took place at home, kindergarten/school, and on the highways/streets/roads, during playing. Most common ways of treatment would include at the emergency settings, self-treated, with older children more likely to treat by themselves. Most injuries were cured.@*Conclusions@#In programs on prevention and control of injuries targeting the left-behind children in poor rural areas, special attention should be given to older boys, on falls and blunt/sharp injuries, at home or kindergarten/school. Education programs should pinpoint on self-rescue skills and guidance on kids by the parents, with behavioral norms and social support included. Related comprehensive prevention and control mechanism should be developed in families, schools and communities, with medical resources and insurance mechanism explored to serve these population and districts, including those left-behind children.

Mechanical thrombectomy with Solitaire AB stent for acute ischemic stroke: comparison between cardioembolic and large artery atherosclerotic stroke / 国际脑血管病杂志

Objective To compare the outcomes of Solitaire AB stent mechanical thrombectomy for the treatment of large-artery atherosclerotic stroke (LAA) and cardioembolic stroke (CES).Methods Acute ischemic stroke patients treated with Solitaire stent retriever device were enrolled retrospectively. They were divided into either a LAA group or a CES group according to the etiology. The outcomes in both groups were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcome (defined as the modified Rankin Scale score > 2) at 90 d after onset. Results A total of 39 patients were enrolled in the study. There were 18 patients in the LAA group (49. 2％), 6 (33. 3％) had good outcome at 90 days; there were 21 patients (50. 8％) in the CES group, 9 (42. 9％) had good outcome at 90 days. There was no significant difference in the the good outcome rate at 90 days in both groups (P = 0. 223). Multivariate logistic regression analysis showed that only age was independently associated with poor outcome (odds ratio 1. 107, 95％ confidence interval 1. 016-1. 206; P = 0. 047), and stroke etiology subtype was not independently associated with poor outcome (odds ratio 0. 671, 95％ confidence interval 0. 078- 5. 743; P = 0. 716). Conclusions There was no significant difference in the clinical outcome between the patents with LAA and CES who received mechanical thrombectomy with Solitaire AB stent.

Effectiveness of integrated early childhood development intervention on nurturing care for children aged 0-35 months in rural China / 中华儿科杂志

Objective@#To explore whether Integrated Early Childhood Development (IECD) program has effectively improved the nurturing care for children aged 0-35 months in rural China.@*Methods@#IECD has been implemented by the government of China with support from the United Nations Children's Fund (UNICEF) in four poverty-stricken rural counties since 2014. The interventions targeting the five key components of nurturing care (i.e. child and caregiver health, child nutrition, early learning support, child protection and social security) were delivered through the IECD program to children aged 0 to 35 months and their caregivers. A population-based intervention trial was designed to evaluate intervention effectiveness with data collected in 2013 (baseline) and 2016 (mid-term). The changes of nurturing care in the intervention and control group were analyzed by using a difference-in-differences (DID) model. This approach provided adjustment for sociodemographic and other confounding factors.@*Results@#The baseline and mid-term survey enrolled 1 468 and 1 384 children in the intervention group, and 1 485 and 1 361 in the control group. After two years of implementation, the prevalence of caregiver's depression in the intervention group showed a decrease of 9.1% (mid-term 34.8% (479/1 377) vs. baseline 43.9% (621/1 414)), whereas that in control group showed a decrease of 1.6% (mid-term 34.3% (464/1 353) vs. baseline 35.9% (509/1 419)). With the confounding adjusted in the difference-in-differences model, the decrease of the caregiver's depression prevalence in the intervention group was 7.0% greater than that in the control group (P=0.008). The qualified rate of minimum meal frequency in the intervention group showed an increase of 10.4% (mid-term 69.0% (532/771) vs. baseline 58.6% (481/821)), whereas the qualified rate in the intervention group showed an increase of 2.9% (mid-term 66.4% (469/706) vs. baseline 63.5% (508/800)). With the confounding adjusted in the difference-in-differences model, the increase of the qualified rate in the intervention group was 8.2% greater than that in the control group (P=0.021). The proportion of violent discipline by caregivers in the intervention group showed a decrease of 6.2% (mid-term 49.1% (478/973) vs. baseline 55.3% (554/1 001)), whereas the proportion in control group showed an increase of 4.5% (mid-term 58.4% (560/959) vs. baseline 53.9% (558/1 036)), and with the confounding adjusted in the difference-in-differences model, the difference in increase rate between two groups was 11.0% (P=0.001). The proportion of families with three or more children's books in the intervention group showed an increase of 12.7% (mid-term 42.7% (588/1 378) vs. baseline 30.0% (432/1 440)), whereas the proportion of the control group showed an increase of 4.2% (mid-term 25.7% (349/1 357) vs. baseline 21.5% (298/1 388)), and with the confounding adjusted in the difference-in-differences model, the difference in increase rate between two groups was 6.1% (P=0.007).@*Conclusions@#The IECD intervention strategy implemented in rural China effectively improved the mental health of caregivers, optimizes families' child feeding and early stimulation behaviors, while reducing violent discipline and other risk factors. IECD provides better nurturing care for the early development of children aged 0-35 months in rural China.

Rescue stenting after failure of mechanical thrombectomy in patients with large vessel occlusive stroke / 国际脑血管病杂志

Objective To investigate the safety and effectiveness of rescue stenting after failure of mechanical thrombectomy in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Methods From December 2015 to December 2017, patients with AIS caused by LVO and treated with Solitaire AB stent thrombectomy in the Fifth Central Hospital of Tianjin were enrolled retrospectively. CT scans were performed within 24 h after surgery. Symptomatic intracraninal hemorrhage (sICH) was defined as CT confirmed intracranial hemorrhage and the National Institutes of Health Stroke Scale score increased ≥4. Clinical outcomes were assessed using the modified Rankin Scale at 90 d after onset, and 0 to 2 was defined as good outcome. According to whether to receive rescue stenting or not, the patients were divided into 2 groups. The clinical outcomes and incidence of sICH were compared between the 2 groups. Results A total of 39 patients were enrolled. Among them, 29 (74. 3％) were successfully recanalized by mechanical thrombectomy and 10 (25. 6％) performed stenting after failure of mechanical thrombectomy. Four (40. 0％) in the stenting group and 11 (37. 9％) the non-stenting group had good outcomes respectively at 90 d. There was no significant difference (P = 1. 000). Two patients (20. 0％) and 1 patient (3. 4％) developed sICH within 24 h after operation in the stenting group and the non-stenting group respectively. There was also no significant difference (P = 0. 156). Conclusions Rescue stenting can be used as a safe and effective remedy for patients with failure of mechanical thrombectomy.

To strengthen the diagnosis and treatment of thyroid diseases in breast cancer patients / 中华内分泌外科杂志

Breast cancer and thyroid diseases are common diseases in women.It is reported that breast cancer and thyroid diseases have some relevance.Breast cancer patients have relatively high incidence of thyroid dysfunction,thyroid node and thyroid cancer,which are easily misdiagnosed for lacking of obvious clinical manifestations and will affect the treatment and prognosis of breast cancer.In breast cancer patients,screening and diagnosis of thyroid function and disease through thyroid function detection and ultrasound examination should be strengthened.

Reliability and validity of warning signs checklist for screening psychological, behavioral and developmental problems of children / 中华儿科杂志

Objective@#To evaluate the reliability and validity of warning signs checklist developed by the National Health and Family Planning Commission of the People′s Republic of China (NHFPC), so as to determine the screening effectiveness of warning signs on developmental problems of early childhood.@*Method@#Stratified random sampling method was used to assess the reliability and validity of checklist of warning sign and 2 110 children 0 to 6 years of age(1 513 low-risk subjects and 597 high-risk subjects) were recruited from 11 provinces of China. The reliability evaluation for the warning signs included the test-retest reliability and interrater reliability. With the use of Age and Stage Questionnaire (ASQ) and Gesell Development Diagnosis Scale (GESELL) as the criterion scales, criterion validity was assessed by determining the correlation and consistency between the screening results of warning signs and the criterion scales.@*Result@#In terms of the warning signs, the screening positive rates at different ages ranged from 10.8%(21/141) to 26.2%(51/137). The median (interquartile) testing time for each subject was 1(0.6) minute. Both the test-retest reliability and interrater reliability of warning signs reached 0.7 or above, indicating that the stability was good. In terms of validity assessment, there was remarkable consistency between ASQ and warning signs, with the Kappa value of 0.63. With the use of GESELL as criterion, it was determined that the sensitivity of warning signs in children with suspected developmental delay was 82.2%, and the specificity was 77.7%. The overall Youden index was 0.6.@*Conclusion@#The reliability and validity of warning signs checklist for screening early childhood developmental problems have met the basic requirements of psychological screening scales, with the characteristics of short testing time and easy operation. Thus, this warning signs checklist can be used for screening psychological and behavioral problems of early childhood, especially in community settings.

Follistatin N terminus differentially regulates muscle size and fat in vivo

Delivery of follistatin (FST) represents a promising strategy for both muscular dystrophies and diabetes, as FST is a robust antagonist of myostatin and activin, which are critical regulators of skeletal muscle and adipose tissues. FST is a multi-domain protein, and deciphering the function of different domains will facilitate novel designs for FST-based therapy. Our study aims to investigate the role of the N-terminal domain (ND) of FST in regulating muscle and fat mass in vivo. Different FST constructs were created and packaged into the adeno-associated viral vector (AAV). Overexpression of wild-type FST in normal mice greatly increased muscle mass while decreasing fat accumulation, whereas overexpression of an N terminus mutant or N terminus-deleted FST had no effect on muscle mass but moderately decreased fat mass. In contrast, FST-I-I containing the complete N terminus and double domain I without domain II and III had no effect on fat but increased skeletal muscle mass. The effects of different constructs on differentiated C2C12 myotubes were consistent with the in vivo finding. We hypothesized that ND was critical for myostatin blockade, mediating the increase in muscle mass, and was less pivotal for activin binding, which accounts for the decrease in the fat tissue. An in vitro TGF-beta1-responsive reporter assay revealed that FST-I-I and N terminus-mutated or -deleted FST showed differential responses to blockade of activin and myostatin. Our study provided direct in vivo evidence for a role of the ND of FST, shedding light on future potential molecular designs for FST-based gene therapy.

Repairation the composite tissue defects of heel by using the free iliac flap with nerve anastomosis / 中华显微外科杂志

Objective To investigate the clinical effects of reconstruction by using the free iliac flap with nerve anastomosis to repair the composite tissue defects of heel.Methods From March 2009 to August 2012,five cases with the composite tissue defects of heel,including 2 cases with the bottom defects and 3 cases with the tibial defects of heel,were repaired by the free iliac flap,and the feeling of the heel were reconstructed by nerve anastomosis of the flap.The ventral wound were sutured simply.Results All iliac flaps survived and the wound healed in one stage.Patients were followed up from 6 months to 12 months.Appearance and function recovered and the feeling recovered from S2-S3.The foots walked freely.The skin of iliac abdomen were scarred and lead to hyperpigmentation.Conclusion Using the free iliac flap with nerve anastomosis could repair the bone and soft tissue defects of heel and reconstruct the sensation of warmth and sense of pain of the heel.With the characteristics of hidden wound and little damage,the clinical effects was satisfied.

The shifting abductor muscle of little finger and metatarsophalangeal joint dorsal articular capsule incision to improve the function of reconstructed thumb / 中华显微外科杂志

Objective To explore the effect of shifting the little finger abductor muscle and cutting open the metatarsophalangeal joint dorsal articular capsule to improve the appearance and function of reconstructed thumb.Methods From August 2007 to May 2012,twelve cases of Ⅳ°or Ⅴ°defect of thumb were repaired by free transplantation of the second toes with metatarsophalangeal joint.During operation,using the abductor muscle of little finger to reconstruct palmar opposition function,cutting open the joint capsule of metatarsophalangeal joint,adjusting the tension of the joint by the little finger abductor muscle and toe short extensor muscles,which were used to improve the appearance and function of reconstructed thumb.Results Twelve reconstructed thumbs all survived.Followed up from 6 to 24 months,the appearance and function were improved obviously.According to the evaluation trial standards,nine cases were optimal and 3 cases were good.Conclusion The shift of the little finger abductor muscle could reconstruct palmar opposition function,combined with metatarsophalangeal joint dorsal articular capsule incision and adjusting joint tension,could improve the appearance and function of reconstructed thumb.The effect of operation was satisfied.

Effect of preoperative visiting by special visiting nurses before operation on relieving mental tension of patients / 中国实用护理杂志

Objective To discuss the influence of preoperative visiting by special visiting nurses before operation on relieving mental tension of patients. Methods 80 patients were randomly divided into the experimental group and the control group with 40 patients in each group.All patients were prepared in the same way except that patients in the experimental group were visited by the operation room nurses before the operation.The differences in heart rate and blood pressure were compared between the two groups as the criteria for judging mental tension of the patients. Results Blood pressure and heart rate of patients in the experimental group did not fluctuate as much as the patients in the control group. Conclusions Visiting patients before the operation can stabilize patients' emotion and reduce their stress reaction and mental tension so as to help them get through the perioperative period more smoothly.

The role of high-sensitivity C-reactive Protein, interleukin-6 and cystatin C in ischemic stroke complicating atrial fibrillation / 华中科技大学学报（医学）（英德文版）

This study examined the role of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6) and cystatin C in ischemic stroke complicating atrial fibrillation (AF) and the relationship of systemic inflammation with this disease in order to identify AF patients who are at high risk of stroke and need optimal anticoagulant therapy. A total of 103 AF patients, simple (n=75) or complicated by ischemic stroke (n=28), and 112 control subjects were recruited. IL-6 level was detected by using enzyme linked immunosorbent assay. Cystatin C and hsCRP levels were measured by means of a particle-enhanced immunonephelometric assay. The results showed that the AF patients had higher levels of hsCRP (P=0.004), IL-6 (P=0.000), and cystatin C (P=0.000) than control subjects. Plasma hsCRP level was increased in the AF patients with ischemic stroke as compared to the patients with simple AF (P=0.036). The AF patients who had the level of hsCRP exceeding 3.83 mg/L were at a higher risk than those with hsCRP level lower than 3.83 mg/L (P=0.030). After adjusting for other factors, cystatin C remained positively associated with IL-6 (r=0.613) and hsCRP (r=0.488). It was concluded that hsCRP is positively correlated with ischemic stroke complicating AF and may be a risk factor independent of other risk factors for AF. Elevated cystatin C level is also indicative of the increased risk of AF.

Effect of human tissue kallikrein gene therapy on insulin resistance and nephropathy in type 2 diabetic rats / 中华内分泌代谢杂志

Objective To evaluate the therapeutic effect of recombinant adeno-associated viral vector (rAAV) expressing human tissue kallikrein gene (rAAV-HK) on insulin resistance and renal complications in tyDe2 diabetic rats. Methods Male Wistar rats were injected low dose streptozotocin and fed with high fat and sucrose diets to form type 2 diabetic model. rAAV mediated HK gene (HK group) or LacZ gene (LacZ group) were introduced to the diabetic rats, and their systolic blood pressure, fasting blood glucose and insulin, serum creatinine, urine creatinine, urine osmolarity and urine microalbumin were measured. The homeostasis model assessment of insulin resistance (HOMA-IR), urinary albumin excretion rate (UAER) and creatinine clearance rate (Ccr) were calculated. The expression of PI3-kinase p11o catalytic subunit (p110) and Akt phosphorylation on Thr-308 were detected by Western blot. The morphology of kidney wag observed. Results Delivery of rAAVHK resulted in a reduction in blood pressure at 2 weeks and the hypotensive effect lasted for the duration of the study. The HOMA-IR was significantly lower in HK group than LacZ group (4.76±0.33 vs 8.36±0.48, P<0.01) at the end of the study, fasting insulin level was reduced [(8.19±2.45 vs 13.85±3.76)mIU/L. P<0.01], but there was no significant change in fasting blood glucose [(13.09±3.01 vs 13.58±2.88)mmol/L].The phosphorylation of p11o and Akt Thr-308 were significantly decreased in skeletal muscle and liver in LacZ group and were almost corrected by HK gene therapy. The UAER and Ccr were significantly lower and urinary osmolarity were higher in HK-treated rats compared with LaeZ rats. Histological assessment indicated that the renal complication was relieved by HK gene delivery. Conclusion The rAAV-mediated HK gene delivery efficiently attenuated insulin resistance partly through PI3K/Akt pathway and diabetic nephropathy in type 2diabetic rats.

Effect of tissue kallikrein gene treatment on blood pressure in type 2 diabetic rats and its mechanism / 中国病理生理杂志

AIM: To study the effect of tissue kallikrein gene (HK) treatment on blood pressure in type 2 diabetic rats and its mechanism. METHODS: Male Wistar rats were injected with low dose streptozotocin and fed with diets enriched in fat and sugar to form type 2 diabetic model. Recombinant adeno-associated viral vectors (rAAV)-mediated HK gene (HK group) or LacZ gene (LacZ group) was introduced to the diabetic rats. The systolic blood pressure was measured every 2 weeks. The acetylcholine (Ach)-dependent vasodilation response, the synthesis of nitric oxide (NO), the expression of endothelin-1 (ET-1) and endothelin-A receptor (ET_A-R) in the aorta were detected. RESULTS: (1) Systolic blood pressure was significantly higher in diabetic rats than that in normal control rats. In HK group, systolic blood pressure was significantly reduced within 2 weeks after injection with rAAV?HK, reached near normal levels at 4 weeks and kept until the experiments ended (16 weeks). (2) In LacZ group, Ach-dependent vasodilation response of isolated aorta was markedly decreased than that in HK group (P

Analysis of Antipsychotics Used in Six Cities of the Yangtze River Valley During the Period 1997～2001 / 中国药房

OBJECTIVE:To investigate the current situation and developing trend of the use of antipsychotics.METHODS:The data of antipsychotics in Analysis System of Drug-use in the Hospitals of the Yangtze River Valley,reported by Hangzhou,Shanghai,Nanjing,Wuhan,Chengdu and Chongqing during the period 1997～2001,were analysed by using DDD as index.RESULTS:The sum of money and frequency of use of the antipsychotics were increasing year by year;The first generation antipsychotics still occupied the marketing predominance;The use of the second generation antipsychotics assumed an increasing tendency year by year.CONCLUSION:The marketing of antipsychotics will further expand in China and the pharmaceutical factories should strengthen the development of new antipsychotics.