ObjectiveTo improve the quality and service performance of community visual health services in Shanghai, and to establish a set of reasonable and effective evaluation index system for community visual health services. MethodsCentered on the national and Shanghai-based visual health policies and based on the current status and development trends of community visual health service program in Shanghai, the candidate indicators were formed through literature review and expert interviews, firstly. The framework of an evaluation index system was formulated through qualitative research successively, which was further revised and perfected using the Delphi method. Coefficient weights were calculated using the analytic hierarchy process (AHP), culminating in the establishment of the community visual health evaluation index system, lastly. ResultsA total of 22 visual health experts from district-level center for disease control, hospital ophthalmology and leaders in charging of visual health service in community health centers participated in the Delphi questionnaire survey, with a questionnaire recovery rate of 100% and an expert authority coefficient of 0.86, indicating high credibility. After a round of correspondence to experts’ importance ratings and discussions, a comprehensive evaluation index system comprising 3 primary indicators, 12 secondary indicators, and 47 tertiary indicators, along with 5 additional indicators, was finalized. ConclusionAn index system tailored to effective evaluation for community visual health initiatives was drawn up in this study, which can promote the capacity building in community eye health services, facilitating the high-quality development of visual health courses, and enhancing residents’ eye health.

Guillain-Barre syndrome rarely develops after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and only a few reports exist in China. Guillain-Barre syndrome is an acute and life-threatening condition that requires early diagnosis and treatment. A patient with acute myeloid leukemia underwent allogeneic HSCT for >5 months and gradually developed limb muscle weakness and limited eye movement after coexisting with delayed acute intestinal graft-versus-host disease. After the examination of cerebrospinal fluid and electromyography, the diagnosis of Guillain–Barre syndrome was confirmed. After a high-dose intravenous immunoglobulin (IVIg) treatment, muscle strength gradually recovered, and the prognosis was good.

The onset of myasthenia gravis (MG) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) seriously threatens the survival of patients, since it is acute, and is prone to rapid progression. Two patients with acute myeloid leukemia (AML), who had undergone allo-HSCT developed shortness of breath, and gradually developed cervical weakness and dyspnea. The acetylcholine receptor (AChR) antibody and neostigmine test enabled the diagnosis of MG. The condition of the patients improved after treatment with pyridostigmine bromide, glucocorticoids and rituximab.

Objective:To evaluate the application value of transabdominal wall suspended laparoscopic appendectomy (LA) in patients with acute suppurative appendicitis or concurrent periappendiceal abscess.Methods:The clinical data of 107 patients with acute suppurative appendicitis or concurrent periappendiceal abscess in Hexi University, Zhangye People′s Hospital from September 2019 to December 2022 were retrospectively analyzed. Among them, 53 patients underwent open appendectomy (OA) (OA group), and 54 patients underwent transabdominal wall suspended LA (LA group). The operation time, postoperative pain score, postoperative hospitalization time, recovery time of gastrointestinal function, postoperative complications and hospital cost were compared between two groups.Results:In the LA group, 2 cases were transferred to OA due to heavy abdominal adhesion and unclear anatomy, and 3 cases could not undergo transabdominal wall suspended LA due to perforation of the root of the appendix or gangrene of the appendix. There was no statistical difference in operation time between two groups ( P>0.05); the postoperative hospitalization time, recovery time of gastrointestinal function, postoperative pain score and total incidence of postoperative complications in LA group were significantly lower than those in OA group: (4.92 ± 1.70) d vs. (7.51 ± 3.96) d, (20.64 ± 7.37) h vs. (35.32 ± 10.13) h, (5.62 ± 1.12) scores vs. (6.83 ± 0.93) scores and 5.56% (3/54) vs. 24.53% (13/53), the hospital cost was significantly higher than that in OA group: (8 325.47 ± 856.22) yuan vs. (6 458.64 ± 2 085.93) yuan, and there were statistical differences ( P<0.05). Conclusions:Transabdominal wall suspended LA has the advantages of wide indications, easy operation, minimal trauma, fast recovery, and fewer complications, but with relatively high hospitalization cost.

Objective:To evaluate the effect of applying high-fidelity simulation model in the teaching of lower urinary tract injury.Methods:A total of 50 junior medical students majoring in clinical medicine were enrolled. They were randomly assigned to the control group or the experimental group. The students in the control group were taught using the traditional method involving PPT presentation and videos on lower urinary tract anatomy, surgical basis of lower urinary tract injury, and operative methods for lower urinary tract injury. The students in the experimental group were taught using the simulation model for observation and related operation. After four class hours (40 minutes/class hour) of teaching, the students in the two groups were subjected to theoretical assessment and questionnaire survey. The differences between the two groups were compared and analyzed using the t and χ 2 tests in SPSS 26.0. Results:The total scores of theoretical assessment were (36.80±4.00) and (33.12±3.62) in the experimental group and the control group, respectively, and the difference was significant ( P<0.05). The results of the questionnaire showed that the self-evaluation of the experimental group was better than that of the control group in the mastery of theoretical knowledge, clinical operation, early treatment, operation process, and key steps, and the differences were statistically significant ( P<0.05). Conclusions:Compared with the traditional teaching method, the high-fidelity simulation model improves the efficiency of learning anatomy knowledge and operation process, and promotes the mastery of important and difficult knowledge in lower urinary tract injury. This method merits popularization.

AIM:To explore the therapeutic effect and possible molecular mechanisms of prednisone combined with icariin(ICA)on hormone resistant nephrotic syndrome(SRNS).METHODS:In the in vi-vo experiment,rats were divided into control group,SRNS group,prednisone group,and P+I group.Each group was given corresponding drugs for 6 weeks.Detection of 24-hour urinary protein in rats using CBB;The blood biochemistry analyzer de-tects rat albumin,total cholesterol,triglycerides,creatinine,and urea nitrogen;HE and Masson were used to detect morphological changes in rat kidney tissue;Immunohistochemical detection of GR-α,GR-β,NLRP3,caspase-1,GSDMD,IL-1β.In the in vi-tro experiment,HK-2 cell injury model with doxoru-bicin,divided into control group,SRNS group,pred-nisone group,P+l group.GR-α,GR-β,NLRP3,cas-pase-1,GSDMD were detected by Rt-PCR and West-ern blot.RESULTS:In the in vivo experiment,com-pared with the control group,the SRNS group showed weight loss,increased 24-hour urine pro-tein,decreased albumin,increased total cholester-ol,triglycerides,creatinine,and urea nitrogen,renal tubular atrophy,increased renal interstitial area,sig-nificant infiltration of inflammatory cells,fibrous tis-sue proliferation,and GR-β,NLRP3,caspase-1,GSD-MD,IL-1 β in renal tissue decreased(P＜0.01);Com-pared with the SRNS group,the combined group showed weight gain,decreased 24-hour urine pro-tein,increased albumin,decreased total cholester-ol,triglycerides,creatinine,and urea nitrogen,re-duced renal tubular atrophy,reduced interstitial in-flammatory cell infiltration,reduced fibrosis,and and GR-α,NLRP3,caspase-1,GSDMD in renal tissue decreased increased(P＜0.01).In vitro experiments,compared with the control group,the model group showed GR-β,NLRP3,caspase-1,and GSDMD in-creased(P＜0.01),GR-α decreased(P＜0.01);Com-pared with the SRNS group,GR-β,NLRP3,caspase-1,and GSDMD decreased(P＜0.01),GR-α increased in the P+I group.CONCLUSION:The combination of prednisone and ICA has a protective effect on the kidneys of SRNS rats and can improve the therapeu-tic effect.The mechanism may be related to the NL-RP3/Caspase-1/GSDMD pathway.

Objective:To explore the efficacy of central combined peripheral dual-target magnetic stimulation on Parkinson disease (PD) patients with freezing of gait (FOG).Methods:A total of 39 patients with FOG diagnosed at the Parkinson disease clinic of the Affiliated Hospital of Nantong University were included in the study from July 2022 to September 2023.They were randomly divided into observation group ( n=20) and control group ( n=19) by the random number table method. The patients in control group were treated with repetitive transcranial magnetic stimulation (rTMS), while the patients in observation group were treated with additional repetitive peripheral magnetic stimulation(rPMS) on the affected tibialis anterior muscle on the basis of the control group. Other clinical medical treatments were the same for both groups of patients.The timed up and go test (TUGT), 10 meter walk test (10MWT), and motor evoked potentials (MEP) were used to evaluate the efficacy before and after 2 weeks of treatment.The SPSS 25.0 software was used for statistical analysis. Independent sample t-test was used for comparison between the two groups, and paired sample t-test was used for comparison before and after treatment within group. Results:Before treatment, there were no statistically significant difference in TUGT time, 10MWT speed and MEP amplitude between the two groups( t=0.659, 0.514, 0.345, all P>0.05).After treatment, the TUGT time((7.87±1.74) s vs (9.31±1.57)s)and MEP amplitude((41.59±14.81)mV vs (58.26±19.26) mV)of the observation group were lower than those of the control group( t=2.723, 3.039, P=0.010, 0.004), while the 10MWT speed of the observation group was higher than that of the control group ((1.21±0.20) m/s vs (1.01±0.17)m/s, t=3.173, P=0.003).After treatment, the TUGT time and MEP amplitude of patients in the observation group and control group were all lower than before treatment (observation group: t=13.512, 7.126, both P<0.001; control group: t=6.535, 3.094, both P<0.05). The 10MWT speeds of patients in the observation group and control group after treatment were both higher than before treatment ( t=25.665, 6.750, both P<0.001). Conclusion:The combination of central and peripheral dual-target magnetic stimulation may improve the FOG of PD patients, and it is worthy of clinical promotion.

Objective:To analyze the correlation between paraspinal muscle parameters and the angle of degenerative thoracolumbar segmental kyphosis.Methods:From November 2021 to April 2023, a total of 90 female patients with lumbar degenerative disease who underwent surgical treatment in the Department of Spine Surgery, Beijing Jishuitan Hospital were retrospectively analyzed. The average age was 67.62±4.98 years (range, 60-80 years), and the average height was 1.58±0.05 m (range, 1.48-1.70 m). Weight 63.79±9.13 kg (range, 47-90 kg), body mass index 25.48±3.35 kg/m 2 (range, 18.37-36.05 kg/m 2). The angle of kyphosis of the thoracolumbar segments was 6.65°±10.38° (range, -17.34° to 9.34°). Disease diagnosis: 32 cases of lumbar disc herniation and 58 cases of lumbar spinal stenosis. Frontal and lateral radiographs of the thoracolumbar segments in the standing position were taken to measure the angle of kyphosis of the thoracolumbar segments; quantitative CT of the thoracolumbar segments and Osirix software were used to measure the parameters of the paravertebral muscles at the levels of T 12, L 3, and L 5, including paravertebral muscle cross-sectional area, skeletal muscle area, and tissue density, the proportion of fat infiltration, and the height-corrected skeletal muscle area index. The correlation between paraspinal muscle parameters and the angle of thoracolumbar segmental kyphosis was analyzed, and the factors affecting the angle of thoracolumbar segmental kyphosis were analyzed using multiple linear regression. Results:Correlation analysis showed a negative correlation between the angle of thoracolumbar segmental kyphosis and the tissue density of T 12 skeletal muscle ( r=-0.303, P=0.004) and L 5 skeletal muscle ( r=-0.219, P=0.038). Age was negatively correlated with T 12 skeletal muscle tissue density ( r=-0.263, P=0.012), T 12 height-corrected skeletal muscle area index ( r=-0.221, P=0.036), T 12 paravertebral muscle cross-sectional area ( r=-0.280, P=0.007), L 3 skeletal muscle tissue density ( r=-0.266, P=0.011) and L 5 skeletal muscle tissue density ( r=-0.290, P=0.006). There was no correlation between bone mineral density and paravertebral muscle parameters ( P>0.05). Multiple linear regression showed that T 12 skeletal muscle tissue density ( β=-1.125, P<0.001), T 12 fat-infiltrated proportion ( β=-0.849, P=0.001), L 3 skeletal muscle tissue density ( β=0.996, P<0.001), and L 3 fat-infiltrated proportion ( β=0.496, P=0.020) were independent factors influencing the angle of thoracolumbar segmental kyphosis . Conclusion:T 12 and L 3 paraspinal muscle density and fat-infiltrated proportion are independent factors affecting the angle of thoracolumbar kyphosis. The smaller the density and fat-infiltrated proportion of T 12 paraspinal muscle, and the larger the density and fat-infiltrated proportion of L 3 paraspinal muscle, the larger the angle of thoracolumbar kyphosis.

Nowadays the contents and form of community pharmaceutical services have become more complex, it is necessary to develop pharmaceutical services in line with the characteristics of community and meeting the actual needs of patients. The "dual drug" refers the combination of pharmaceutical effects of the drug with the language effects of pharmacists. This paper reviews the status quo of pharmaceutical services at home and abroad, patient needs and demands, problems and challenges in pharmaceutical services. The article introduces the experiences of development and implementation of pharmaceutical services based on the"dual drug"priciple, and the preliminary results in author′s institution, to provide reference for a nevel model of pharmaceutical services.

Objective:To investigate the clinical characteristics and treatment of patients with perianal necrotizing fasciitis.Methods:This study was a retrospective cohort study. Twenty patients with perianal necrotizing fasciitis who met the inclusion criteria were admitted to the Department of Burn and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University (hereinafter referred to as our department) from August 2013 to September 2023, including 19 males and 1 female, aged 24-74 (56±11) years. Based on the spreading route of perianal infection to the lower abdomen, the patients were divided into perianal-inguinal-lower abdominal wall group (12 cases) and perianal-pelvic cavity-retroperitoneal group (8 cases). The following clinical data were compared between the two groups of patients: general data, including gender, age, combined underlying diseases, blood glucose level and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score when admitted to our department, and laboratory risk indicator for necrotizing fasciitis (LRINEC) score when admitted to our department and at 14 d after admitted to our department; infection indicators when admitted to our department, including C-reactive protein level, white blood cell count, lymphocyte count, procalcitonin level, and lactic acid level; clinical outcome-related indicators, including time from onset to definite infection range, number of surgery, treatment in intensive care unit (ICU), length of hospital stay, treatment outcome, and recurrence of necrotizing fasciitis during follow-up; detection of pathogen and bacterial drug resistance in wound necrotic tissue specimen when admitted to our department.Results:Compared with those in perianal-inguinal-lower abdominal wall group, the APACHE Ⅱ score and lactic acid level when admitted to our department and LRINEC score at 14 d after admitted to our department (with t values of -5.98, -5.01, and -2.86, respectively, P<0.05) and ICU treatment ratio ( P<0.05) were significantly increased, the time from onset to definite infection range was significantly prolonged ( Z=-3.75, P<0.05), and the number of surgery was significantly increased ( Z=2.80, P<0.05) in patients in perianal-pelvic cavity-retroperitoneal group. There were no statistically significant differences in other data between the two groups of patients ( P>0.05). Eighteen patients were cured, and no recurrence of perianal necrotizing fasciitis was observed during follow-up of 6 months in 18 cured patients. The main bacteria were Escherichia coliand Klebsiella pneumoniae, and the fungui were Aspergillus and Candida albicans detected in wound necrotic tissue specimens in two groups of patients when admitted to our department. The ratio of multiple drug resistance of bacteria in wound necrotic tissue specimens in perianal-pelvic cavity-retroperitoneal group of patients was significantly higher than that in perianal-inguinal-lower abdominal wall group ( P<0.05). Conclusions:Perianal necrotizing fasciitis can spread to the lower abdomen through two routes: the perianal-inguinal-lower abdominal wall route and the perianal-pelvic cavity-retroperitoneal route. The latter is more insidious in disease progression and more challenging in treatment. Establishing a mechanism of multi-disciplinary team diagnosis and treatment can achieve the goal of early diagnosis and precise treatment of perianal necrotizing fasciitis.