Diabetic foot is one of the chronic complications of diabetes,which has great harm.Through active treatment such as anti-infection,debridement,surgical intervention,amputation rate can be declined.

Objective To explore chest physical therapy combined with improved postural drainage method, applied in patients with esophageal cancer after operation .Methods A total of 60 patients with esophageal cancer after operation from October 2010 to October 2012 were selected and randomly divided into observation group ( n=30 ) and control group ( n=30 ) .Control group received the routine nursing such as chest physical therapy (roll over, right back, take a deep breath and cough) and wet phlegm,while observation group received the improved postural drainage on the basis of routine nursing .Then, compared two groups of removal time of chest drainage tube , from bed activity time , postoperative pneumonia , pulmonary atelectasis situation.Results Patients of chest drainage tube removal time [(2.433 ±1.063) vs (3.066 ±1.112)], from bed activity time [(1.950 ±1.044) vs (2.666 ±1.109)] in observation group was significantly shorten than that in control group (t =2.263,3.006;P <0.05).And the incidence of postoperative atelectasis in observation group was significantly lower than that in control group (3.3%vs 16.7%;χ2 =4.043,P<0.05). While no significant difference was found in the incidence of pneumonia between observation group and control group ( P >0.05 ).Conclusions Chest physical therapy combined with improved postural drainage can effectively prevent the incidence of postoperative atelectasis , which is advantageous to chest drainage and the recovery of lung function and .

Objective? To explore the effects of standardized training base on post competency among new recruiting nurses. Methods? By convenience sampling, we selected 168 new recruiting nurses in 2015 at the Central Hospital of Wuhan in control group who attended standardized training from April 2015 to March 2017 receiving routine training methods, and 176 new recruiting nurses in 2016 in observation group who attended standardized training from April 2016 to March 2018 trained in standardized training base. After training, nurses of two groups were given theoretical examination and comprehensive ability examination. Post competency and satisfaction of nurses between two groups were assessed with the post competency scale for new recruiting nurses and training satisfaction questionnaire respectively. Results? Two years after training, the theoretical examination, comprehensive ability examination and the score of post competency scale for new recruiting nurses of new nurses in observation group were (88.32±7.39), (85.42±6.75) and (88.21±6.83) higher than those in control group with statistical differences (P ＜ 0.01). After training, new nurses' satisfaction of observation group was (94.31±6.19) higher than that (83.27±5.72) of control group with a statistical difference (t=17.159, P＜ 0.01). Conclusions? Standardized training base can improve post competency of new recruiting nurses which helps new nurses adapt the post as early as possible.

OBJECTIVE： To investigate the situation and problems of clinical microecological preparations in pediatrics department of China， and to provide reference for rational application of microecological preparations in children. METHODS： Outpatient/emergency prescriptions of microecological preparations during Jan.-Mar. 2019 were retrieved from information system of 5 “Third Grade Class A” children hospitals， and were investigated and analyzed in respects of the type of microecological agents， age distribution， clinical diagnosis， drug combination， off-label medication， etc. RESULTS： A total of 74 210 outpatient/emergency prescriptions were collected， involving 18 kinds of microecological preparations. Among them， Clostridium butyricum combined viable powder ranked first （31 146， accounting for 41.97％）， followed by Brucella yeast powder （14 289， accounting for 19.25％） and Compound Lactobacillus acidophilus tablets （10 281， 13.85％）. The age of children was less than 18 years old， and the proportion of children aged 1-＜3 years old was the highest （33 753， 45.48％）. The most common clinical diagnosis     was digestive tract diseases （54 009， 72.78％）， followed    by respiratory infectious diseases （11 744， 15.83％）. In combination with microecological agents， there were Chinese patent medicine for invigorating the spleen and stomach     （18 546， 24.99％）， antibacterial medicine （10 595， 14.28％） and oral rehydration salt Ⅲ （8 238， 11.10％）. Off-label drug use was found in 19 532 prescriptions （26.32％）， mainly manifesting as super-indications （15 590， 21.01％）， super-usage and dosage （8 098， 14.52％）， super crowd medication （48， 3.91％） was found in a few prescriptions. CONCLUSIONS： There is a high incidence of off-label use of microecological agents in children. Medical staff should standardize prescription behavior and promote rational use of drugs. At the same time， the improvement of the information of children’s medication in drug instructions to ensure the safety and effectiveness of children’s medication should be encouraged.

Objective:To investigate the prevalence and risk factors of tessellation fundus (TF) among Tianjin Medical University students with different refractive statuses.Methods:A cross-sectional study. From September to December 2019, 346 students from Tianjin Medical University were randomly selected and underwent slit-lamp examination, non-cycloplegic auto-refraction, subjective refraction, best-corrected visual acuity, ocular biometric measurement, and non-dilation fundus photography. The differences in the prevalence of TF in basic characteristics and ocular biometric parameters were compared. Based on the equivalent spherical (SE), refractive status was divided into the non-myopia group (SE>-0.50 D) and the myopia group (SE≤-0.50 D). The myopia group was further divided into mild myopia group (-3.00 D26 mm group. The logistic regression was used to analyze the risk factors affecting TF. Trend tests were performed for each risk factor and TF.Results:Of the 346 subjects, 324 (93.6%, 324/346) were myopia, of whom 73 (21.1%, 73/346), 167 (48.3%, 167/346), and 84 (24.3%, 84/346) were mild myopia, moderate myopia, and high myopia, respectively; 22 (6.4%, 22/346) were non-myopia. There were 294 (85.0%, 294/346) students with TF in the macula, including 9 (40.91%, 9/22), 58 (79.45%, 58/73), 145 (86.83%, 145/167), and 82 (97.62%, 82/84) in non-myopia, low myopia, moderate myopia, and high myopia group, respectively; 52 (15.0%, 52/346) students were without TF in the macula. There were statistically significant gender differences ( χ2=4.47), SE ( t=6.29), AL ( t=-8.29), anterior chamber depth ( Z=-2.62), lens thickness ( Z=-2.23), and average corneal radius ( Z=-3.58) between students with and without TF in the macula ( P<0.05). Spherical equivalent and axial length were independent risk factors for TF and its severity ( P≤0.001). With an increasing degree of myopia, and increasing axial length, the risk of TF increased ( P for trend<0.001). Conclusions:The prevalence of TF is 85.0% among Tianjin Medical University students. TF is detected in the fundus of no myopia, mild myopia, moderate myopia and high myopia. The degree of myopia is higher, the AL is longer, the possibility of TF is higher.

Objective:To evaluate the accuracy, completeness, and reproducibility of domestic open-source large language models (LLM) in diabetic retinopathy (DR) patient education, and to explore their potential as intelligent virtual assistants for DR patient education.Methods:A total of 41 questions and answers related to the diagnosis and treatment of DR in five categories, namely risk factors, screening and examination, symptoms and staging, diagnosis, treatment and prognosis.All questions were repeated twice as a " new dialogue" in the LLM, and all the answers were recorded.Three senior fundus physicians independently evaluated the answers on a 6-point Likert scale for accuracy and a 3-point Likert scale for completeness and repeatability, and for each answer, the evaluator was asked to make a recommendation between the LLM and the manual answers.Five questions were randomly selected to evaluate the three open source LLM, ERNIE Bot 3.5, Qwen and Kimi chat, and the LLM with the best overall performance was selected for further evaluation in the full question bank.Results:Among the three LLM, Kimi chat had the best overall performance, Kimi chat performed best, with percentages of 6 for accuracy, 3 for completeness, and 3 for repeatability among the 5 questions at 90%, 90%, and 100%, respectively.For all questions answered, the number of words in manual replies was 106 (70, 202), which was significantly lower than 505 (386, 600) in Kimi chat ( Z=-7.866, P<0.001).There was no significant correlation between the number of Kimi chat replies and the accuracy score ( rs=-0.044, P=0.492), but it was positively correlated with the integrity score ( rs=0.239, P<0.001).The interclass correlation coefficient for accuracy and completeness scores were above 0.700 among three evaluators, with the highest agreement for repeatability at 0.853, followed by completeness of the first response at 0.771.The proportion of responses ≥5 points for accuracy was 87.0%(214/246), the proportion ≥2 points for completeness was 98.0%(241/246), and the proportion higher than 70% for repeatability was 78.5%(193/246).Kimi chat excelled in answering basic questions about the disease such as disease definition, staging, frequency of screening, and common risk factors, but performed poorly on questions involving treatment choices that require a doctor's professional judgment.The proportion of evaluators choosing Kimi chat responses as superior was 69.5% (171/246), and the reasons for non-selection included lack of characteristic answers, inclusion of too much irrelevant information, and lack of responses to questions requiring a high degree of medical expertise. Conclusions:Kimi chat answers DR-related diagnostic questions in a detailed and well-organized manner, with a high degree of accuracy, completeness and reproducibility.

Objective:To evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy (PPV).Methods:A retrospective clinical study. 17 528 surgeries in 10 895 eyes of 10 895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study. Among them, 5 346 eyes in 5 346 cases were male; 5 549 eyes in 5 549 cases were female. The age ranged from 0 to 95 years, with the mean age of (57.74±13.15) years. 6 381 surgeries in 3 615 eyes from August 2015 to December 2018 (the initial period of day surgery) were used as the control group; 11 147 surgeries in 7 280 eyes from January 2019 to June 2023 (the expanded period of day surgery) were used as the observation group. According to the management mode of ambulatory surgery, the observation group was subdivided into the decentralized management group (January 2019 to December 2020) and the centralized management group (January 2021 to June 2023), with 2 905 and 4 375 eyes and 4 646 and 6 501 surgeries, respectively. Changes in the percentage of day surgery, average hospitalization days, and average unplanned reoperation rate were compared. The Mann-Whitney U test was used to compare numerical variables between groups; the chi-square test or Fisher's exact test was used to compare categorical variables. Results:The number of cases of daytime PPV performed in the observation group and control group was 7 852 (70.44%, 7 852/11 147) and 24 (0.38%, 24/6 381) cases, respectively, and the average hospitalization days were 1 (1) and 5 (3) d. Compared with the control group, the observation group had a significantly higher percentage of day surgery ( χ2=8 051.01) and a considerably lower mean hospitalization day ( Z=4 536 844.50), and the differences were statistically significant ( P<0.000 1). The mean hospitalization days in the decentralized and centralized management groups were 2 (3) and 1 (0) d, respectively, and unplanned reoperations were 34 (0.73%, 34/4 646) and 171 (2.63%, 171/6 501) eyes, respectively. Compared with the decentralized management group, average hospitalization days was significantly lower ( Z=1 436.94) and unplanned reoperation rate was significantly higher ( χ2=54.10) were significantly lower in the centralized management group, both of which were statistically significant ( P<0.000 1). Conclusion:PPV ambulatory management model can significantly reduce the average hospitalization day, but also results in higher rates of unplanned reoperations.