Objective To research the significance of application of clinical nursing pathway in patients undertaking glossectomy and forearm flap reconstruction.Methods Sixty patients with tongue cancer who undertook glossectomy and forearm flap reconstruction were enrolled.The patients were randomly divided into the experimental group and the control group (30 cases in each group).The patients of the experimental group received nursing following clinical nursing pathway,and the patients in the control group received routine nursing service.The patients and doctors satisfaction evaluation were compared between the two groups with a self-designed nursing quality evaluation form.The qualities of care achieved in 2 groups were compared.Results It took less in-ward time and expenditure in the experimental group compared with the control group.The quality of care,the satisfactory degree of patients and doctors in the exipermental group were significantly higher than those of the control group.Conclusions The establishment and application of the clinical nursing pathway in patients undertaking glossectomy and forearm flap reconstrucition contributes to improve the satisfaction of patients and doctors and the quality of nursing service.

Objective: To investigate the clinical features and reliable diagnostic method in HIV/AIDS patients with smear negative pulmonary tuberculosis (TB). Methods: Clinical data of 112 HIV/AIDS patients complicated with smear negative pulmonary TB who were treated in our hospital from January 2013 to September 2015 were retrospectively analyzed. These clinical data includeded clinical symptom, blood routine test, blood biochemistry, T lymphocyte subsets classification, sputum acid-fast bacillus smear, mycobacterium tuberculosis culture, purified protein derivatives tuberculin (PPD) test, interferon gamma-release assay for Mycobacterium tuberculosis (T-SPOT.TB), TB-DNA and chest computed tomography (CT). Diagnostic specificity and sensitivity of these parameters were analyzed. Results: No specific clinical manifestation of these patients was identified. The chest CT feature was also atypical. The positive rates including T-SPOT, TB, TB-DNA and PPD test were all low. The positive rates of T-SPOT.TB and PPD test in patients with a CD4+ cell count >200 cells/μl was significantly higher than that of patients with a CD4+ cell count ≤50 cells/μl and 51≤CD4≤200 cells/μl (P<0.01). Conclusions The clinical feature of smear negative pulmonary TB in HIV/AIDS patients is atypical. For a definite diagnosis, a comprehensive analysis with clinical manifestations, laboratory test, imaging examination and etiologic detection is required.

Objective To identify the role of phosphatidylinositol-3-kinase(PI3K) in mediating necroptosis induced by tumor necrosis factor alpha (TNFα) and the involved mechanism.Methods Knockdown of p110α,receptor-interacting protein 1(RIP1) or both p110αand RIP1 was mediated by the specific short hairpin RNA (shRNA) lentivirus and verified by RT-PCR or Western blotting .In addition , Western blotting was used to detect phosphorylation of mixed lineage kinase domain-like protein(MLKL) and protein kinase B(AKT) or tetramerization of MLKL.Cell death was measured by micros-copy and flow cytometry.Results AKT phosphorylation and TNFα-induced necroptosis of L929 cells were suppressed by the inhibitors of PI3K or AKT, as well as p110αknockdown.Moreover, RIP1 knockdown did not inhibit L929 cell death induced by TNFαplus Z-VAD, but the RIP1-independent necroptosis was inhibited by p 110αknockdown.In addition, p110αknockdown suppressed MLKL phosphorylation and tetramerization induced by TNFαwith Z-VAD in L929 cells. Conclusion PI3K mediates necroptosis of L929 cells induced by TNFαby activating AKT and MLKL, respectively.

OBJECTIVETo compare the clinical efficacy on chronic pelvic inflammation between the acupoint embedding therapy and acupuncture, and to compare the efficacy of different patterns/syndroms in differentiation treated with acupoint embedding therapy.

METHODSTwo hundred and eighteen cases were randomized into an embedding therapy group (115 cases) and an acupuncture group (103 cases). In both groups, Shenshu (BL 23), Guanyuanshu (BL 26), Zigong (EX-CA 1), Yaoyangguan (GV 3), Guanyuan (CV 4) and Qihai (CV 6) were selected as the main points. For qi and blood stagnation pattern/syndrome, Zhongdu (LR 6), Diji (SP 8) and the others were added; for cold and damp stagnation pattern/syndrome, Diji (SP 8) and Sanyinjiao (SP 6) were added; for stasis and phlegm pattern/syndrome due to spleen deficiency, Sanyinjiao (SP 6) and Zusanli (ST 36) were added. In the embedding therapy group, the catgut was embedded at 7 - 13 acupoints each time, once every 10 days. In the acupuncture group, the conventional acupuncture therapy was applied, once a day. The symptom scores were assessed in the aspects of the lower abdominal pain severity and attack frequency, lumbosacral soreness and distention, abnormality of vaginal discharge and the others. The efficacy was compared between the two groups.

RESULTSThe total effective rate was 93.0% (107/115) in the embedding therapy group, which was better than 83.5% (86/103) in the acupuncture group (P < 0.05). The symptom scores were all reduced after treatment in the two groups (all P < 0.05). In the embedding therapy group, the efficacies were not significantly different among different patterns/syndromes (all P > 0.05).

CONCLUSIONThe acupoint embedding therapy achieves the definite efficacy on chronic pelvic inflammation and obtains the similar efficacies among the different differentiated patterns/syndromes of the disease.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Catgut ; utilization ; Chronic Disease ; therapy ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Pelvic Inflammatory Disease ; diagnosis ; therapy ; Prostheses and Implants ; Treatment Outcome ; Young Adult

The pathogenesis of burning mouth syndrome (BMS) is not clear. Most scholars believe that primary BMS is a chronic neurological disease. Advanced diagnostic methods such as quantitative sensory testing (QST), trigeminal neuron electrophysiological recording and peripheral nerve blockade, structural analysis of epidermal nerve fiber density (ENFD), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) classify neuropathic pain in most BMS patients as peripheral or central. Hormone replacement, dopaminergic drugs and noninvasive neuromodulation may be new approaches to BMS based on its pathogenesis. This article reviews the clinical features, pathophysiological mechanism, new diagnostic methods and treatment of primary BMS and provides new ideas for the clinical diagnosis and treatment of BMS.

Objective:To understand the incidence, severity and the change trajectory of symptoms in adult patients with acute leukemia during treatment, so as to provide a reference for clinical medical staff to conduct specific symptom screening and management.Methods:From March 2017 to August 2018, 69 patients who were newly diagnosed with acute leukemia at the Nanfang Hospital of Southern Medical University were conveniently selected. The Memory Symptom Assessment Scale was used to investigate the patients before chemotherapy (T1), after the first chemotherapy (T2), after the second to third chemotherapy (T3) and after the fourth to fifth chemotherapy (T4).Results:The severity score of psychological symptoms in adult patients with acute leukemia at T1, T2, T3, and T4 were 1.00(0.58, 1.42), 1.00(0.83, 1.67), 0.67(0.33, 1.00) and 0.67(0.33, 1.00). The severity score of physical symptoms at T1, T2, T3, and T4 were 0.50(0.21, 0.83), 1.00(0.54, 1.33), 0.75(0.58, 1.17) and 0.92(0.63, 1.08), respectively. The score difference was statistically significant ( H = 28.34, 27.14, both P<0.01) at different time points. The score of physical symptoms reached a peak at T2. In the psychological dimension, the severity and incidence of energy deficiency were higher in T1-T4. Conclusions:Adult acute leukemia patients have different focal symptoms in different treatment stages. Clinical medical staff should provide effective and personalized nursing intervention for patients in different treatment stages.

Objectives:To investigate common problems analysis and improvements of medical records writing in the standardized residency training of ophthalmology.Methods:A total of 100 defective medical records of Renmin Hospital of Wuhan University from September 2019 to January 2020 were collected and analyzed for the problems and the reasons, as well as the improvements.Results:A total of 286 defects were found in these 100 medical records. Of which, content-related defects were detected in 89 medical records (31.12%), while quality-related problems were found in 151 records (52.80%). In addition, other defects were found in 46 records (16.08%). Major reasons included personal attitude, insufficient ophthalmic knowledge, heavy workload, lack of standardized guidance and insufficient communicational skills.Conclusion:By analyzing the major reasons of medical records writing, the following approaches, including standardized pre-job training, learning of medical dispute cases and online training, communicational skills training, in-time feedback and evaluation improvement, would be help to reduce the defects in the medical records written by ophthalmic residents.

Objective: To investigate the refractive status of children and adolescents aged 4-18 years in Chengdu, and to analyze the epidemiological characteristics of refractive parameters. Methods: A cross sectional survey was conducted among 82 024 children and adolescents aged 4-18 years in Gaoxin District of Chengdu from August to September 2021. The prevalence of screening myopia, low vision rate, high myopia rate, refractive status and axial development were analyzed. Results: The prevalence of screening myopia in students aged 4-18 years was 40.42%(33 158/82 024). Low myopia was 24.51%(20 108/82 024), moderate myopia was 13.05%(10 703/82 024) and high myopia was 2.86%(2 347/82 024). The prevalence of screening myopia was 1.81% (233/12 848) in kindergarten, 34.44%(17 095/49 644) in primary school, 79.73%(9 738/12 214) in junior high school and 83.25% (6 092/7 318) in senior high school. The rate of visual impairment increased by year from the age of 4, and the rate of myopia increased most rapidly from 6 to 15 years old, the prevalenct of high myopia was compared between adjacent age groups: there were statistical differences between 9-15 years old were more likely to be nearsighted than boys( P <0.035 7). Significant differences in screening myopia between 5- and 7-17 year old groups,and in boys and girls.The median total diopter was 0.40 D at the age of 4 and developed to -2.90 D at the age of 18 . The diopter of girls aged 8-15 years was higher than that of boys, and there was statistical significance( Z=-2.53, -4.09, -5.67, -8.64, -5.56, -4.97, -2.52, -2.14, P <0.05). The axial length gradually increased with age, with the mean value of (22.31±0.59) mm at 4 years old and (24.91±1.00) mm at 18 years old. The mean corneal curvature did not change with age (43.19±1.47)D. Conclusion 6-15 years old is a especially critical period for myopia development. More efforts need to be taken to decrease the prevalence of myopia before 6 years old. Prevention of the development of high myopia should start before the age of 10. The prevalence of myopia in girls is higher than that in boys, more prevention and control of myopia should focus on girls.

Objective:To investigate the clinical phenotype and genetic characteristics of infantile epileptic spasm syndrome caused by BRWD3 gene mutation. Methods:Clinical data of a child with BRWD3 related infantile epileptic spasm syndrome who was admitted to Department of Pediatric Neurology of Linyi People′s Hospital on August 2, 2019 were collected and followed up, whole exome sequencing technology and Sanger sequencing were applied to verify the child and his parents, and the pathogenicity of mutation site was analyzed. The studies till June 2023 were searched with keywords of " BRWD3" in both English and Chinese databases of China National Knowledge Infrastructure, Wanfang, Online Mendelian Inheritance in Man, and PubMed. The clinical phenotype and genetic characteristics of patients with BRWD3 related epilepsy were summarized. Results:The patient was a 4 years and 4 months old boy, with a clinical phenotype including severe global development delay, focal seizures (the onset age was 4 months), epileptic spasm (the onset age was 6 months), autism, megacephaly, high forehead as well as hypsarrhythmia. The whole exome sequencing results showed a de novo and frameshift variation c.4318_4319del(p.Q1441Efs*20)(NM_153252) in the BRWD3 gene, and the variation was interpreted as pathogenic (PVS1+PS2+PM2) according to the American College of Medical Genetics and Genomics variant classification criteria and guidelines. A total of 7 English literature articles were retrieved reporting 16 cases of BRWD3 gene related epilepsy in children (including 1 case of infantile epileptic spasm syndrome), and there has been no report in China yet. Totally there were 17 cases of BRWD3 gene related epilepsy including this case. All the cases showed X chromosome dominant inheritance, of whom 15 cases showed minor variations, including 7 missense variations, 3 frameshift variations, 3 splicing variations, 2 nonsense variations, and the remaining 2 cases showed large segment deletions. A total of 15 different variants were found. The phenotypes of the 17 patients mainly included epileptic seizures (17/17), intellectual disability (10/17), motor development disorder (7/17), speech impairment (9/17), megacephaly (8/17), facial malformation (8/17), autism (4/17) and hypotonia (4/17). The common seizure types were found to be focal seizures, occasionally epileptic spasm seizures and tonic seizures. Conclusions:BRWD3 gene variation related epilepsy is an X chromosome dominant genetic disease with a wide clinical phenotype spectrum. BRWD3 gene mutation c.4318_4319del(p.Q1441Efs *20) could cause infantile epileptic spasm syndrome, manifested as severe global developmental delay, epileptic spasm, focal seizures, autism, craniofacial malformation and hypsarrhythmia. This research enriches BRWD3 gene mutation spectrum.

Objective:To explore the potential mechanism of Fuzheng Jiedu Decoction created by professor Yu Huiping in the treatment of primary immune thrombocytopenia (ITP) in children based on network pharmacology.Methods:The targets of Fuzheng Jiedu Decoction and ITP were retrieved within SymMap database and TCMID database, and all the common genes in the potential targets of the decoction and ITP were retained. The interaction relationship among the targets was obtained in the String database, and cluster analysis was conducted to obtain the core target group of Fuzheng Jiedu Decoction for ITP. In the David database, the potential KEGG Pathway was obtained through enrichment analysis, the Pathway of non-specific diseases was classified and selected, and a network of "Traditional Chinese Medicine - Target - Pathway" was constructed.Results:There are 500 potential targets for Fuzheng Jiedu Decoction to treat ITP. After Cluster analysis of PPI network, a total of 16 gene clusters were obtained, among which Cluster 1 score was 65.663, making it a potential core target group for Fuzheng Jiedu Decoction to treat ITP. The core enriched target group amounts to 114 pathways, and there were four first-level catalogs which includes Human Diseases (50%), Organismal Systems (25%), Environmental Information Processing (17%), and Cellular Processes (8%). Among them, TNF signaling pathway and HIF-1 signaling pathway were highly enriched for non-specific diseases. In the nodes of the network, The Chinese herbs with the highest Degree of aggregation in the network nodes were Agrimoniae herba (Degree=66), Glycyrrhizae radix et rhizoma praeparata cum melle (Degree=64), the target proteins were MAPK3 (Degree=51),MAPK1 (Degree=50),and the pathway was PI3K-Akt signaling pathway (Degree=29). Conclusion:Fuzheng Jiedu Decoction is mainly used to treat children's ITP with Agrimoniae herba and Glycyrrhizae radix et rhizoma praeparata cum melle,and it is related to the regulation of platelet number, adhesion and focusing.