Objective To analyze efficacy and its influencing factors of phenobarbital treatment for epilepsy management in rural China.Methods Total 3 315 patients with convulsive epilepsy from rural areas of 24 counties were enrolled in this joint epilepsy management program.All patients received phenobarbital monotherapy for 1 year during November 2011 to November 2013.The efficacy and potential influencing factors including sex,age,duration of epilepsy,number of seizures in the 12 months before management(≥2),previous treatment,daily dose of phenobarbital,taking other antiepileptic drugs and compliance of patients were studied with multivariate analysis.Results Among 3 315 patients,38.9％ were seizure-free during the entire management period.The rates of seizure-free in 15 to 39 y age group (35.2％,495/1 405)and in patients receiving irregular treatment previously (34.6％,625/1 808)were lower.The rates of seizure-free were higher in patients taking phenobarbital 60-90 mg everyday (49.4％,988/2 000) and those with good compliance(42.3％,1 160/2 744).Patients taking other antiepileptic drugs in 12 months had lower seizure-free rate (31.0％,45/145).Univariate analysis showed that gender of patients was not related to seizure-free rate (P ＞ 0.1).Multivariate analysis showed that the longer duration of epilepsy(OR =0.015,95％ CI:1.008-1.021,P ＜ 0.001),more seizures in the 12 months (OR =0.005,95％ CI:1.002-1.007,P =0.002) and the irregular treatment before management were the risk factors for low seizure-free rate (P ＜ 0.05).Patients received formal treatment or untreated had a lower risk of seizure compare with the irregular treatment (OR =0.737,95％ CI:0.611-0.889,P =0.001;OR =0.566,95％ CI:0.469-0.683,P ＜0.001).Patients with good compliance and with a daily dose of 60-89 mg phenobarbital(OR =0.107,95％ CI:0.013-0.905,P =0.040) were associated with high seizurefree rate;in contrast the poor compliance was a risk factor for not being seizure-free(OR =2.038,95％ CI:1.634-2.541,P ＜ 0.001).Conclusion Regular medication of phenobarbital with good compliance is effective for convulsive epilepsy management in rural China.

Objective To investigate the pathogenic mutations of BRCA1 and BRCA2 in patients with early-onset breast cancer(≤35 years) and explore the relationships between BRCA1/2 mutations and clinical features.Methods Seventy-four patients with early-onset breast cancer were enrolled,who were treated in Hospital 307 between September 2014 and June 2016.High-throughput sequencing was used to test the 49 exon sequences and adjacent sequences of BRCA1 and BRCA2.χ2 test was used to analyze the distribution of BRCA1/2 pathogenic mutations in each group that was set up according to clinical features.Results Fifteen mutations(20.27%) were identified,including 5(6.76%) in BRCA1 and 10(13.51%) in BRCA2.Eleven new pathogenic mutations were discovered,and BRCA1:c.5470_5477delTGCCCAAT was found in one patient.The frequency of BRCA1/2 mutations in the group with a family history of breast cancer or ovarian cancer was higher than in the group without a family history (40.91% vs 11.54%) (χ2=6.534,P=0.011).Conclusion BRCA1/2 pathogenic mutation is significant for early-onset breast cancer,especially for those with a family history of breast or ovarian cancer.The new mutations may be specific to Chinese people.BRCA1:c.5470_5477delTGCCCAAT may be the ancestor mutation among the Chinese.

Objective:To investigate the repair method and curative effect of iatrogenic penis skin necrosis of varying degrees.Methods:From June 2016 to December 2018, a total of 20 patients with varying degrees of iatrogenic penis skin necrosis were treated in our center. According to the area of the necrotic skin of penis, different treatment methods were selected: 2 patients with change dressing; 9 patients with relaxation suture; 7 patients with scrotal skin flap based on one side anterior scrotal artery; 2 patients with penile embedded in scrotum and secondary repair.Results:All patients were cured, there was no infection and flap necrosis. All of the patients were satisfied with the appearance of the penis, the flaps of anterior scrotal artery flap and scrotal pedicle embedding the penis survived well and the penis erectile function was not affected during the follow-up for 6 to 12 months.Conclusions:For patients of varying degrees of iatrogenic penis skin necrosis, individualized treatment should be adopted, which can effectively repair the penile defects and achieve satisfactory effect.

Objective:To investigate the use intention of patients with coronary heart disease for mobile health and understand needs of patients for gamification design of mobile health platform, in order to improve the self-management level of patients with coronary heart disease by building a gamified mobile health platform.Methods:Using the convenient sampling method, a total of 181 hospitalized patients with coronary heart disease (CHD) in Department of Cardiology from July to September 2020 (3 hospitals in Beijing and 1 hospital in Heilongjiang Province) were selected as research objects. Questionnaire on the usage needs of mobile health platform for coronary heart disease was used to investigate them.Results:Only 8 of the 181 patients (4.42%) used cardiac mobile health, and 113 (62.43%) patients never used cardiac mobile health but would consider using it. But 60 (33.15%) patients never used cardiac mobile medical experience and said that they won' t use it in the future, and the reasons included operation, language, safety, need awareness and health concerns. Among 121 patients with coronary heart disease, the top three requirements for gamification design were human-computer interaction encouragement and company (32.23%) , completion of tasks to exchange for real prizes (30.58%) and health ranking (28.10%) .Conclusions:Based on needs of patients, an easy-to-use, scientific and readable gamified mobile health platform for coronary heart disease should be built, mobile health publicity should be increased, and the continuous use rate of the mobile health platform and the self-management of patients should be improved.

Objective:To develop and evaluate the Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease.Methods:The item pool of the Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease was formed through literature review and expert consultation. Items were screened by combining frequency, correlation coefficient, Cronbach's α coefficient and factor analysis. Subjective and objective weighting was used to determine the weight of items, and diagnostic threshold was determined by receiver operator characteristic curve. Cronbach's α coefficient and factor analysis were used to test the reliability and validity of the scale.Results:The Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease had a total of 6 syndrome elements and 36 items. It included 3 items of blood stasis, 9 items of phlegm, 7 items of Qi stagnation, 5 items of Qi deficiency, 6 items of Yin deficiency, and 6 items of Yang deficiency, and the diagnostic thresholds were 1.000, 45.300, 36.400, 66.600, 33.900, and 30.500 respectively. The test-retest reliability coefficients of each dimension of the scale were all greater than 0.7, and the internal consistency reliability coefficients of each dimension were 0.540 to 0.848. In the factor analysis, each variable with a common factor load coefficient greater than 0.4 was extracted, and the results were completely consistent with the scale entry settings. The cumulative variance contribution rate was 53.822%.Conclusions:The reliability and validity of the Self-rating Identification Scale for Common Syndromic Elements of Coronary Heart Disease are good, and it has scientific research and clinical application value.

Purpose/Significance To construct a risk prediction model for postoperative massive bleeding in nasopharyngeal carcino-ma after radiotherapy,and to evaluate its predictive performance.Method/Process Inpatients with major bleeding after radiotherapy for nasopharyngeal cancer in the First Affiliated Hospital of Zhengzhou University from 2016 to 2019 are selected as the study objects,and the same number of patients without major bleeding are randomly selected as the control group.The medical record index data of the two groups of patients are collected,and various machine learning algorithms are applied respectively and the optimal algorithm is selected to build the model.Result/Conclusion The model based on support vector machine(SVM)algorithm has a recall rate of 0.94,an F1 val-ue of 0.93,and a precision of 0.93,showing the best performance.It can be used to construct a prediction model for postoperative mas-sive bleeding in nasopharyngeal carcinoma,and provide more accurate personalized prediction for patients,which has good clinical appli-cation prospects.

Objective:To evaluate the usability of gamification coronary heart disease health management platform based on WeChat, so as to provide support for self-management of coronary heart disease patients.Methods:From November to December 2022, 10 patients with coronary heart disease who were treated at Dongzhimen Hospital of Beijing University of Chinese Medicine were selected using convenience sampling. The research subjects registered for the health management platform by scanning the QR code and underwent a 2-month trial experience. Two months later, researchers collected data from the platform and used a combination of questionnaire surveys and qualitative interviews to investigate the user's experience and feedback of the research subjects, in order to evaluate the usability of the platform.Results:Within two months, the health management platform had 226 visits, an average visit time of 26 minutes, and an availability questionnaire score of (71.8±2.8). The research subjects had an acceptable attitude towards the usability of this platform, had a good overall user experience, and had also provided improvement suggestions for the platform while they gained beneficial experiences.Conclusions:The gamification coronary heart disease health management platform based on WeChat has good usability, providing a feasible means for the health management of heart disease patients, and also providing reference for other chronic disease health management projects involving lifestyle changes and incentives.

Objective To investigate the clinical implications of serum tenascin-C (TNC) levels for lung injury and the prognosis in acute paraquat (PQ) poisoning patients.Methods Clinical data of acute PQ poisoning patients hospitalized in Emergency Department of First Hospital of China Medical University from January 1 to December 31,2017 were prospectively collected.Patients' serum samples were obtained on admission and serum TNC levels were quantified by a commercially available enzymelinked immunosorbent assays (ELISA) kit.Patients were followed up to 28 d after poisoning and divided into the survival and non-survival groups.The differences of clinical data together with serum TNC level between the two groups were analyzed by univariable analysis.The correlation between serum TNC level and liver function,renal function and artery blood gas results was analyzed.Logistic regression analysis was used for assessing the independent risk factors of death.ROC curves of related parameters were plotted and the area under the curve (AUC) was calculated.Results Eighty-two patients were enrolled in this study:35 patients in the non-survival group and 47 patients in the survival group.There was no significant difference of data on admission between the two groups,including pH,PaO2,Cr,BUN,ALT,TBil,AMS,TNC,lung CT positive rate.But PaCO2,Lac,urine paraquat concentration and serum TNC level on admission were significantly different between the survival and non-survival groups.Furthermore,serum TNC level was correlated significantly with the worst PaO2 value,pH,and lung CT positive rate within 72 h from admission,especially the worst PaO2 value (r=-0.801,P＜0.01).Logistic regression analysis showed that the serum TNC level on admission was an independent risk factor for the prognosis of acute PQ poisoning patients.The AUC was 0.895 and the cutoff value was 41.9 ng/mL.Conclusion The early serum TNC level in acute PQ poisoning patients can predict the degree of lung injury and evaluate the prognosis.

Objective To investigate the efficacy and safety of endoscopic ultrasound-guided gallbladder drainage ( EUS-GBD) for patients with acute cholecystitis, who are unfit for cholecystectomy. Methods Patients who underwent EUS-GBD at Hangzhou First People′s Hospital from April 2015 to December 2016 were enrolled in this study. Clinical data were collected, and effectiveness and complications were analyzed. Results EUS-GBD was achieved in all 5 patients, and the mean procedure time of EUS-GBD was 26. 0±3. 1 min. Double pigtail plastic stents were successfully placed in 4 patients. A nasobiliary drainage tube was placed in 1 patient and the tube was endoscopically cut 5 days after procedure acting as internal drainage. All patients recovered without complications and no procedure-related death occurred. During the follow-up period (46-692 d), no patient experienced recurrent cholecystitis and stent migration. Conclusion At an experienced endoscopic center, EUS-GBD is a safe, effective and minimally invasive method for patients with acute cholecystitis and high surgical risk.

Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography ( ERCP ) for the diagnosis and treatment of children with pancreaticobiliary diseases. Methods Clinical data of 115 children with pancreaticobiliary diseases who underwent ERCP between July 2006 and June 2016 at Hangzhou First People' s Hospital were reviewed. Anesthesia types, therapeutic methods,success rate and postoperative complications were summarized. Results A total of 221 ERCP procedures were performed on 115 patients. Eighty one cases were diagnosed as common bile duct stones, 22 bile duct cysts, 3 biliary ascariasis, 66 chronic pancreatitis, 45 pancreas divisum, and 43 acute pancreatitis. Thirty-one procedures were performed under general anesthesia. Dissection of pancreatic duct and biliary duct, calculus removal, insertion of pancreatic duct and biliary duct, and draining in pancreatic duct or biliary duct were performed. The success rate of the ERCP procedure was 98. 6％ ( 218/221) with complication rate of 7. 2％( 16/221 ) . In terms of postoperative complications, post-ERCP pancreatitisoccurred in 7 ( 3. 2％) cases, bleeding in 5 ( 2. 3％) , and postoperative cholangitis in 4 ( 1. 8％) . All the complications were cured after treatment. Conclusion Congenital anatomic anomalies are common in children with pancreaticobiliary diseases. Early diagnosis and treatment of ERCP by an experienced endoscopist for children with pancreaticobiliary diseases is effective and safe.