Objective To explore the safety and effectiveness of using low molecular weight heparin (LMWH) in place of warfarin for anticoagulation in patients with a previous cardiac valve replacement. Methods We reviewed 70 patients hospitalized from Jan 2002 to Apr 2009 undergoing abdominal surgery who have had a previous cardiac valve replacement and had been on warfarin anticoagulation therapy. LMWH began to replace warfarin for anticoagulation 3 clay before the surgery in 33 cases, while the other 37 patients simply ceased to use any anticoagulant since 3 days before the surgery. Postoperative bleeding and embolism risk were compared between these two groups. Results There were 2 patients suffering from postoperative bleeding in the operative field in LMWH group, while there was no postoperative bleeding in patients on anticoagulant suspension group (χ~2=0.641, P>0.05). There was no valve embolism occurred in these two groups. Conclusions It is a safe way to stop using warfarin with LMWH taking the task for perioperative anticoagulation in patients with a history of cardiac valve replacement 3 days before an elective abdominal surgery. This protocol decreases the risk rate of valve embolism not at the expense of increasing postoperative bleeding.

The study on medical education directly affects the quality of education and cultivation of medical professionals as well as the level of running school.It is very important for the medical colleges to take some measures to solve these problems existing in medical teaching reform and research,such as renewing teachers' ideas,enhancing the standardization of management,increasing the enthusiasm of the teachers etc.

Objective To investigate the effect of postoperative TSH suppression on bone mineral density (BMD) in postmenopausal women with DTC.Methods Postmenopausal women with postoperative DTC underwent thyroid residual ablation or 131I treatment for metastases at Xin Hua Hospital between September 2009 and December 2014 were enrolled and followed for 2 years.They were divided into suppressive TSH group (median TSH＜0.30 mU/L;group 1) and non-suppressive group (median TSH≥0.30 mU/L;group 2).Lumber 1-4 BMD levels (T scores) were measured by a dual energy X-ray absorptiometry bone densitometer at baseline,1 year and 2 years after treatment.All patients had calcium and vitamin D supplementation after TSH suppression.The T scores were compared with Mann-Whitney u test and Kruskal-Wallis test.Results A total of 126 patients were enrolled and followed up for 2 years,including 65 with average age (57.65±6.65) years in group 1 and 61 with average age (56.19±7.17) years in group 2.The T scores in group 1 and group 2 at baseline were-1.70(-2.30,-0.55) and-1.30(-2.10,-0.30) (z=-1.660,P＞ 0.05).The difference of T scores was significant in group 1 at baseline,1-year follow-up and 2-year follow-up (-2.25(-2.48,-0.83),-1.95(-2.70,-0.60);H=6.244,P＜0.05),but not significantly different in group 2 (H=1.102,P＞0.05).The T values were different between the 2 groups both in 1-year follow-up and 2-year follow-up (z values:-2.170,-2.160,both P＜0.05).Conclusions TSH suppression significantly increases the risk of postoperative osteoporosis.The BMD should be followed up annually in postmenopausal DTC patients.

Objective To study the validity of RAND-UCLA (Rand Corporation and University of California at Los Angeles) consensus panel method in developing guidelines of referral indications for low back pain (LBP).Methods Evidence-based clinical guidelines for LBP management at community level and its referral guidelines published since 2001 and other tools were retrieved with varied tools.All clinical guidelines met inclusion criteria were evaluated with clinical studies and evaluation tools (AGREE).An pool of indication items was established based on evidence for developing referral indications for LBP, which were added by RAND-UCLA consensus panel method, and alternative referral indications were selected and clinical guidelines for LBP referral were established.Results A total of 15 copies of clinical guidelines from nine countries or regions were included in it after critical appraisal.Four copies of referral guidelines from two countries were included.Referral indications for LBP were derived directly from the RAND-UCLA consensus panel process, consisting of 44 referral indications for three groups (immediate, urgent and routine referral).Conclusions The RAND-UCLA consensus panel method is a more useful and practical tool in developing clinical guidelines, referral guidelines, which is worthwhile being recommended and spread.

BACKGROUND/AIMS: Several studies have demonstrated that sleep problems are associated with functional gastrointestinal disorders (FGIDs): irritable bowel syndrome (IBS), functional dyspepsia, etc, but the relationship between excessive daytime sleepiness (EDS) and FGIDs has not been systematically studied in the general population. This study aims to explore the relationship between EDS and specific types of FGIDs and the effect of the number of FGIDs on EDS. METHODS: A sample of 3600 individuals (aged 18–80 years) was selected from 5 regions in China using a randomized, stratified, multi-stage sampling method. EDS was measured by the Epworth Sleepiness Scale, while gastroesophageal reflux disease (GERD) and other FGIDs were assessed by Reflux Disease Questionnaire and the Rome II diagnostic criteria, respectively. RESULTS: The survey was completed by 2906 individuals (response rate: 80.72%), and 644 individuals (22.16%) had EDS. EDS was significantly associated with ulcer-like dyspepsia (OR, 2.50; 95% CI, 1.08–5.79), diarrhea-predominant IBS (OR, 2.00; 95% CI, 1.09–3.66), alternating IBS (OR, 2.32; 95% CI, 1.30–4.13), functional constipation (OR, 1.68; 95% CI, 1.20–2.35), and GERD (OR, 1.72; 95% CI, 1.08–2.72). Risk of EDS increased along with the increasing numbers of FGIDs: with 1 FGID (OR, 1.72; 95% CI, 1.37–2.15); with 2 FGIDs (OR, 2.43; 95% CI, 1.63–3.62); and with 3 or more FGIDs (OR, 3.26; 95% CI, 1.37–7.78). CONCLUSIONS: FGIDs, such as ulcer-like dyspepsia, diarrhea-predominant IBS, alternating IBS, functional constipation, and GERD, were significantly associated with EDS. Those who suffered from more kinds of FGIDs were more susceptible to EDS.
China* ; Constipation ; Disorders of Excessive Somnolence ; Dyspepsia ; Epidemiology ; Gastroesophageal Reflux ; Gastrointestinal Diseases* ; Irritable Bowel Syndrome ; Methods

Objective To investigate the application effect of group therapy in improving the subjective well-being (SWB) of elderly patients with long-term hospitalization. Methods Totally 100 cases of elderly patients admitted in geriatric ward of Ningbo First Hospital for long-time were selected. Newfoundland scale of happiness (MUNSH) scale and the negative life events questionnaire were used to investigate elderly inpatients, and patients with MUNSH ≤12 points received group therapy. Patients were divided into several groups to receive the intervention according to the negative life events. One year after intervention,patients receiving group therapy were evaluated again by using MUNSH scale to evaluate the intervention effect. Results Among 100 elderly patients,there were 32 cases of high SWB,3 cases of low SWB,and 65 cases of medium SWB. 53 cases of patients had sleep disorders,and 62.26% of them had low SWB. After intervention,the scores of negative experience and emotion of elderly patients were lower than those before intervention (P<0.05);the scores of positive emotion and positive experience and the total MUNSH score were higher than those before intervention (P < 0.05). Conclusions According to the different influencing factors,group interventions can significantly improve the SWB level of elderly patients with long-term hospitalization,so as to improve their quality of life.

Circular RNA (circRNA) is widely expressed in eukaryotes. Abnormal expression of specific circRNA was found in both animal models with cognitive decline and patients with cognitive dysfunction.However, the role of circRNA in cognitive dysfunction related diseases is still unclear. By introducing the expression of circRNA in cognitive function related brain regions and its impact on brain structure and function, as well as the relevant research progress on the pathological mechanism of circRNA involvement in cognitive dysfunction related diseases, this review provides theoretical basis for revealing the pathological mechanism of circRNA in cognitive dysfunction related diseases and discovering specific circRNA targets for preventing and treating cognitive dysfunction.

Objective: To analyze the relationship between 24 h movement behaviors and cognitive function in children and adolescents, as well as the isotemporal substitution benefits, in order to provide a basis for developing cognitive development intervention strategies among children and adolescents. Methods: Relevant studies were searched in the Web of Science, PubMed, Embase, EBSCO, and China National Knowledge Infrastructure databases from their inception to November 30, 2024. Systematic evaluation was performed after document screening, data extraction and quality assessment. Results: A total of 24 highquality studies were included, comprising 35 295 children and adolescents aged 3-18 years. Adhering to the 24 h activity guidelines was associated with better cognitive performance (19 studies). Additionally, substituting 5-30 minutes per day of moderate to vigorous physical activity (MVPA) or sleep (SLP) for sedentary behavior (SB) or light physical activity (LPA) were associated with improvements in cognitive function (7 studies). There were inconsistencies in the effects of different types of SB (learning or entertainment) on cognitive function. Conclusions Adherence to the 24 h activity guidelines supports cognitive development in children and adolescents, with MVPA and SLP as key intervention targets. Increasing the proportion of MVPA, ensuring adequate SLP, and limiting recreational SB and screen time might be helpful to enhance the combined benefits of these three behaviors.

Objective:To investigate the value of 18F-FDG PET/CT imaging in the diagnosis of suspected autoimmune encephalitis (AE) in children with epilepsy and negative MRI. Methods:From May 2019 to August 2022, 94 suspected AE children (49 males, 45 females; age 1-15 years) with epilepsy and negative MRI who underwent brain 18F-FDG PET/CT imaging at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. All patients were divided into AE and non-AE groups based on clinical final diagnosis. The effectiveness of visual diagnosis was evaluated. The cortical lesion extent score (S), and SUV max, SUV mean and minimum of SUV (SUV min) of cortical lesions (L), basal ganglia (B) and thalamus (T) were measured and SUV ratios (SUVR) of L/B or L/T were obtained. Independent-sample t test or Mann-Whitney U test was used to analyze data. Binary logistic regression analysis was used to screen the diagnostic factors of AE, and a diagnostic model was established. The diagnostic efficiency was evaluated by ROC curve analysis and Delong test. Results:There were 53 cases in AE group and 41 cases in non-AE group. Based on visual analysis, the sensitivity, specificity and accuracy of 18F-FDG PET/CT for AE were 100%(53/53), 43.9%(18/41) and 75.5%(71/94), respectively. Differences of LSUV max, LSUV mean, LSUV min, L/BSUVR max, L/BSUVR mean, L/BSUVR min, L/TSUVR max, L/TSUVR mean, L/TSUVR min and S between AE and non-AE groups were statistically significant ( z=-6.74, t values: from -8.51 to -3.97, all P<0.001). ROC curve analysis showed that the AUC of L/BSUVR max was the highest (0.914) among visual analysis and semi-quantitative parameters. Logistic regression analysis showed that S (odds ratio ( OR)=11.40, 95% CI: 2.18-59.52, P=0.004), L/BSUVR max( OR=13.19, 95% CI: 2.11-82.51, P=0.006) and L/TSUVR max( OR=9.66, 95% CI: 1.57-59.55, P=0.015) were independent diagnostic factors for AE. Regression model was established: P=1/(1+ e - x), x=2.433×S+ 2.580×L/BSUVR max+ 2.267×L/TSUVR max-3.802. The AUC of this model was 0.948, with the sensitivity, specificity and accuracy of 98.1%(52/53), 90.2%(37/41) and 94.7%(89/94), respectively. The diagnostic efficacy of the optimized scoring system was consistent with the pre-optimization model, and were both superior to L/BSUVR max(both z=2.01, both P=0.040). Conclusion:The diagnostic model and scoring system based on the semi-quantitative analysis of 18F-FDG PET/CT have better diagnostic efficacy for AE and are superior to semi-quantitative parameters alone.