Objective To explore the effects of the 4C continuing care model on the living ability and neurological function in patients with cerebral apoplexy during the rehabilitation period.Methods Totally 112 patients with cerebral apoplexy admitted in No.3 Ward of Qiongyuan People's Hospital from July 2014 to July 2016 and divided into the observation group (n=56) and the control group (n=56). Patients in the control group received conventional nursing care, while patients in the observation group received 4C continuing care. The patients' living ability, limb movement function and neurological function 1, 6 and 12 month before and after intervention were recorded and compared between the two groups.Results There was no statistical difference in the scores of living ability and neurological function between the two groups before intervention (P>0.05), However, there was statistical difference in the scores of living ability and neurological function between the two groups 1, 6 and 12 month after intervention (P<0.05). There was no statistical difference in the scores of limb movement function between the two groups before intervention (P>0.05). However, there was statistical difference in the scores of limb movement function between the two groups 6 month and 12 month after intervention (P<0.05).Conclusions The 4C continuing care model can effectively enhance the living ability and neurological function recovery in patients with cerebral apoplexy during the rehabilitation period.

Objective? To investigate the improving effect of nursing intervention based on Roy adaptation model on sleep condition of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods? A total of 118 patients with AECOPD admitted to Department of Respiratory Medicine, the First Affiliated Hospital of Zhengzhou University from July 2016 to May 2018 were selected by stratified sampling method. They were divided into observation group and control group according to random number table method, with 59 cases in each group. The control group was given conventional nursing care, while the observation group was given nursing intervention based on Roy adaptation model on the basis of the conventional nursing care. Before and after the intervention, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Social Support Rating Scale (SSRS), the Pittsburgh Sleep Quality Index (PSQI) were used to evaluate negative emotions, social support, sleep quality and quality of life of the patients. After the intervention, the nursing satisfaction of the two groups was compared. Results? After 2 weeks of intervention, the scores of SAS (26.33±4.72) and SDS (43.17±6.29) of the observation group were lower than those before intervention;the score of SSRS (34.21±6.95) was higher than that before intervention, and the observation group were all better than the control group, the differences were statistically significant (P＜ 0.05). After intervention, the PSQI scores of the observation group (5.01±1.27) and the control group (6.33±1.74) were statistically different (t=4.707, P＜0.05). The overall satisfaction of the patients in the observation group was 93.33% and that in the control group was 77.97%. There was a significant difference between the two groups (P＜ 0.05). Conclusions? Compared with conventional nursing, nursing intervention based on Roy adaptation model can better improve the negative emotions and social support of AECOPD patients, and improve sleep and nursing satisfaction.

Objective:To analyze the oral phenotype and gene variation of children with hypophosphatasia (HPP), and explore the genotype-phenotype correlations.Methods:Eight children diagnosed with HPP from January 2008 to January 2023 in The Children′s Hospital, Zhejiang University School of Medicine were recruited in this study. The pathogenic genes of 5 of them were sequentially analyzed and all of their oral manifestations, laboratory tests and genetic variation types were retrospectively analyzed.Results:A total of 8 children were recruited in the study, 3 males and 5 females, aged from 20 to 104 months, whose main complaints were premature deciduous tooth loss. Among them, 3 children were diagnosed with odonto HPP, and the other 5 children were diagnosed with childhood HPP, including 2 children was odonto HPP at the first diagnosis and modified as childhood HPP at the age of 5. The age range of first deciduous tooth loss is 9 to 18 months, and the age range of diagnosis was 20 to 104 months. The patients of odonto HPP only showed premature loss of deciduous anterior tooth, while the patients with childhood HPP also showed premature loss of multiple deciduous molars. Panoramic radiographic film revealed enlarged pulp chambers and radicular canals in some primary and permanent teeth. The enamel hypoplasia, hypoplastic short roots, and alveolar resorption of deciduous molar were observed in some cases. The serum alkaline phosphatase (ALP) (30-107 U/L) levels of all the patients were lower than that in the normal children of same age and gender, and the ALP value of the 1-3 years old girls with childhood HPP (30-33 U/L) was lower than that of the three children with odonto HPP (61-107 U/L), but there was no significant difference in statistical analysis. There were 8 variation sites of ALP liver/bone/kidney (ALPL) gene detected in 5 children and their families, all of which were missense variation, including the new variants in the mutations of c.1334C>G (p.Ser445Cys) and c.1259G>T (p.Gly420Val) that were not reported in the literature. One case was autosomal dominant inheritance and other 4 cases were complex heterozygous variation with autosomal recessive inheritance.Conclusions:Pediatric stomatologists are often the first doctors to detect childhood and odonto HPP. Diagnosis of mild HPP is often delayed. The severity of HPP is related to serum ALP level and ALPL gene mutation sites.

Objective:To summarize the ultrasonographic features and prognosis of fetal persistent vitelline artery.Methods:The prenatal ultrasound features, genetic testing results, and prognosis of a fetus with an isolated persistent vitelline artery that was diagnosed in our hospital in December 2021 were retrospectively analyzed. Relevant articles were retrieved from CNKI, VIP, Wanfang, Yiigle, PubMed, Embase, and UpToDate databases using the terms "persistent vitelline artery", "type Ⅱ single umbilical artery", and "prenatal ultrasound" in both Chinese and English. Prenatal ultrasound features and prognosis of the persistent vitelline artery in fetuses were summarized using descriptive statistical analysis.Results:(1) Case report: In this case, ultrasound at 23 gestational weeks showed that an abnormally large blood vessel deriving from the celiac artery near the superior mesenteric artery entered the placenta through the umbilical opening in parallel with the umbilical vein. Color Doppler showed a blood flow spectrum like that in the umbilical artery. The transverse section image showed that bilateral umbilical arteries were not observed in the bladder and the free segment of the umbilical cord was in the shape of the Chinese character "Lyu". No obvious other structural abnormalities and a negative result of genetic testing were observed in the fetus. Followed up to one year old, the patient showed normal growth and development. (2) Literature review: A total of five articles involving four cases were retrieved (three in English and two in Chinese). Among the five cases, including the present case, one was terminated due to left renal agenesis and abnormal heart arteries ratio revealed by prenatal ultrasound, and the remaining four cases without obvious structural abnormalities in the prenatal ultrasound were born and developed well. Histopathological examination of the umbilical cord was performed in three cases, of which two with persistent vitelline artery had a distinct internal elastic lamina, and one with remained vitelline duct.Conclusions:The prenatal ultrasound of fetal persistent vitelline artery is typically characterized by an abnormal vessel that is derived from the abdominal aorta or superior mesenteric artery and plays the function of the umbilical artery. The prognosis of the isolated persistent vitelline artery is good, but a better understanding of such embryonic abnormalities is needed as there are few relevant reports at home and abroad.