Objective To evaluate the effect of tranilast on neointimal proliferation and remodeling of rabbit iliac artery after balloon injury.Methods Twenty four rabbits were randomly divided into 3 groups including sham-operated group, control group, and treatment group. Balloon catheter was used to induce injury to the iliac artery of rabbits in control group and treatment group. Tranilast was given to the rabbits in treatment group (300 mg?kg -1) once a day from 3 days before operation to 28 days after operation, and then local vessels were harvested for pathological analysis and immunohistochemical staining. Automatic image analysis system was used to detect the changes of intimal thickness, medial thickness, luminal area, external elastic lamina (EEL) cross-sectional area and the proliferation index of proliferating cell nuclear antigen (PCNA). Results The intimal thickness was decreased in treatment group compared with control group. The luminal area and EEL cross-sectional area were significantly larger in treatment group than those in control group. No significant difference was found between treatment group and control group in medial thickness. The proliferation index of PCNA was significantly reduced in treatment group compared with control group. Conclusions Tranilast signifcantly inhibited neointimal hyperplasia and prompted compensatory artery dilation during remodeling of rabbit iliac artery after balloon injury. The effect on neointimal hyperplasia may be partly attributed to the inhibition of vascular smooth muscle cell proliferation.

Objective To summarize the experience of multidisciplinary consultation for prenatal fetal deformity, and to explore the mode suitable for China. Methods The Obstetrics and Gynecology Hospital of Fudan University and Children's Hospital of Fudan University established a joint multidisciplinary consultation center, including obstetrics, pediatrics, pediatric surgery, ultrasound and other departments. A total of 3 378 pregnant women visited the consultation center from July 31, 2003 to August 1, 2013. After consultation, treatment was divided into three classes:pregnancy termination, pregnancy continuation and perinatal treatment. Follow-up was made through correspondence and telephone communication. Retrospective analysis on reasons for consultation, fetal structural abnormalities of the classification system, chronological order of abnormalities, gestational weeks of diagnosis, maternal-related factors, treatment and prognosis was performed. Results (1) Reasons for consultation:Among 3 378 women undertaking prenatal multidisciplinary consultation, 3 243 (96.00%) were due to fetal factors, and 135 (4.00%) were due to maternal factors. (2) Classification of fetal structural abnormalities:Among the 3 243 cases undertaking consultation with fetal factors, fetal abnormality was found in 80.85%(2 622/3 243). The most common were neurological abnormalities(23.19%, 608/2 622), followed by urinary tract malformation (20.25%, 531/2 622) and cardiovascular malformation (15.48%, 406/2 622). These were followed by digestive system malformation, limb deformities and space-occupying lesions. There were 156 cases of multiple malformations. (3) Average gestational weeks for diagnosis of fetal deformity:The 2 622 cases of fetal deformity were diagnosed at a mean (26.7± 2.1) of gestational weeks (21.1–30.4 weeks). Urinary tract malformations were detected at (24.0±0.7) weeks, whereas digestive system malformations were detected at (28.3±2.6) weeks. (4) Induced labor:Induced labor cases accounted for 35.66% (935/2 622), among which, 92 cases were fetal intrauterine death and 843 cases were active choice. The several highest induced labor rates resulted from multiple malformations (75.64%, 118/156), abdominal wall defects (62.22%, 28/45), diaphragmatic hernia (61.54%, 24/39), cleft lip and palate (55.32%, 26/47) and cardiovascular malformations (49.51%, 201/406). For nervous system (27.80%, 169/608), urinary tract (25.80%, 137/531) and digestive system malformations (26.94%, 66/245), induced labor rates were <30%. For abdominal lesions (14.04%, 25/178) and sacrococcygeal teratoma (13.64%, 3/22), induced labor rates were<15%. (5) Continuation of pregnancy in 1 687 cases:Cesarean section was conducted in 1 046(61.94%). Neonatal death occurred in 117(6.94%).(6) Perinatal treatment:Twenty-one cases were treated during pregnancy, including thirteen cases with fetal ascites and hydrothorax treated by drainage, five cases with fetal anemia treated by intrauterine transfusion and three cases with fetal tachycardia treated by digoxin. Ten cases were treated by ex-utero intrapartum treatment. After birth, 297 newborns immediately underwent neonatal surgery. Among these, 259 cases underwent radical surgery, eleven palliative surgery, and sixteen elective surgery after follow-up. Conclusions Prenatal multidisciplinary consultation can make comprehensive multidisciplinary assessment of fetal prognosis and improve the diagnosis and treatment of structural malformations.

Forty three medical graduates from Hainan Medical University participating in the standardized general practice residency training in 2015 and 2016 were randomly divided into study group (n=22) and control group (n=21). The study group received a mid-term assessment and formative assessment, and the control group received the final assessment only. At the end of the six months of training, the scores of the mid-term assessment in study group were significantly higher than those in the control group [(82.9±8.4) vs. (75.5±10.2), t=12.706, P<0.01]. A questionnaire survey was conducted among the participants in study group, 86.4% of them recognized and supported the formative assessments. Formative assessment can improve the teaching quality of general practice residency training. The trainees have a positive attitude towards this assessment mode.

Objective To systematically sort out the interventional studies on the application of auricular point sticking technique in patients with urinary calculi by means of evidence map analysis in order to understand the distribution of evidence in this field and the problems of the studies.Meth-ods Chinese and English databases such as CNKI,Wanfang,VIP,China Biology Medicine(CBM)Database,PubMed,Cochrane Library,CINAHL complete,Web of Science,Elsevier Science Direct,Embase,etc.were systematically searched to screen for studies related to the application of auricular point sticking technique in patients with urinary calculi.The time frame of the review was from the database construction to June 2024,and the trend of publication,type of literature,sample size in the literature,interventions,distribution of acupuncture points,outcome indexes,and methodological quality of the literature were analyzed by using graphs and text.Results A total of 79 papers were included,including 65 randomized controlled studies,5 quasi-experimental study,and 9 studies with unclear grouping basis.The overall trend of the number of publications was increasing,and the aver-age sample size was 103.37 patients.The most frequently selected auricular acupuncture points were kidney,ureter,sympathetic point,Shenmen,and bladder,etc.,and the endpoint indicators of greater concern were clinical efficacy,pain relief,and stone expulsion,etc.The methodological quality of the literature was not high.Conclusion Auricular point sticking technique has certain ad-vantages in the treatment of urinary calculi,and the selection of acupoints and outcome indicators are diverse.However,most studies have shortcomings in scientific research design,personalized intervention measures,measurement and analysis of outcome indicators,etc.Therefore,more scientific and rigorous large-scale,multi-center randomized controlled studies are needed in the future to provide high-quality evidence-based basis for the application of auricular point sticking technique in patients with urinary calculi.

Objective To systematically sort out the interventional studies on the application of auricular point sticking technique in patients with urinary calculi by means of evidence map analysis in order to understand the distribution of evidence in this field and the problems of the studies.Meth-ods Chinese and English databases such as CNKI,Wanfang,VIP,China Biology Medicine(CBM)Database,PubMed,Cochrane Library,CINAHL complete,Web of Science,Elsevier Science Direct,Embase,etc.were systematically searched to screen for studies related to the application of auricular point sticking technique in patients with urinary calculi.The time frame of the review was from the database construction to June 2024,and the trend of publication,type of literature,sample size in the literature,interventions,distribution of acupuncture points,outcome indexes,and methodological quality of the literature were analyzed by using graphs and text.Results A total of 79 papers were included,including 65 randomized controlled studies,5 quasi-experimental study,and 9 studies with unclear grouping basis.The overall trend of the number of publications was increasing,and the aver-age sample size was 103.37 patients.The most frequently selected auricular acupuncture points were kidney,ureter,sympathetic point,Shenmen,and bladder,etc.,and the endpoint indicators of greater concern were clinical efficacy,pain relief,and stone expulsion,etc.The methodological quality of the literature was not high.Conclusion Auricular point sticking technique has certain ad-vantages in the treatment of urinary calculi,and the selection of acupoints and outcome indicators are diverse.However,most studies have shortcomings in scientific research design,personalized intervention measures,measurement and analysis of outcome indicators,etc.Therefore,more scientific and rigorous large-scale,multi-center randomized controlled studies are needed in the future to provide high-quality evidence-based basis for the application of auricular point sticking technique in patients with urinary calculi.

Objective To investigate the clinical significance and level changes of uric acid(UA)/albumin(ALB)ratio(UAR)in patients with chronic kidney disease(CKD)complicated with coronary heart disease(CHD).Methods A total of 175 patients with CKD were divided into the simple CKD group(control group,n=94)and the CKD complicated with CHD group(experimental group,n=81).The differences of blood routine,blood lipid,renal function and UAR were compared between the two groups.The influencing factors of CKD complicated with CHD were analyzed by binary Logistic regression.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index for CKD complicated with CHD.Results There were no significant differences in white blood cell count(WBC),monocytes(Mon),total cholesterol(TC),total triglyceride(TG),high-density lipoprotein(HDL-C)and low-density lipoprotein(LDL-C)between the two groups.The levels of neutrophils(Neu),red cell distribution width variation coefficient(RDW-CV),blood urea nitrogen(BUN),creatinine(Cr),UA and UAR levels were higher in the experimental group than those in the control group(R＜0.05).The levels of lymphocyte(Lym),red blood cell count(RBC),mean corpuscular hemoglobin concentration(MCHC),platelet(PLT),estimated glomerular filtration rate(eGFR)and albumin(Alb)were lower in the experimental group than those in the control group(R＜0.05).Logistic regression analysis showed that lower levels of RBC and MCHC,and higher levels of UAR were independent risk factors for CKD complicated with CHD.ROC curve showed that the area under the UAR curve was the largest in RBC,MCHC and UAR detection,which was 0.912(95%CI:0.870-0.953),the sensitivity was 90.10%,the specificity was 77.70%,the Yoden index was 0.678 and the cutoff value was 10.935.The AUC of combined detection of RBC,MCHC and UAR was 0.987(95%CI:0.974-0.999),the sensitivity was 93.80%and the specificity was 97.90%.Conclusion The increased serum UAR level in patients with CKD is a predictor of CHD.The combined detection of UAR,RBC and MCHC has higher prediction efficiency.

Objective:To search, evaluate and summarize the best evidence for oral fluid intake management in adult patients with urinary calculi, providing a decision-making basis for clinical nursing.Methods:Using keywords such as urolithiasis, urinary calculi, fluid intake, water intake, fluid, etc., a systematic search was conducted in relevant domestic and international databases, guideline websites, and professional association sites for evidence related to oral fluid intake management in adult urolithiasis patients. This included clinical decisions, best practices, guidelines, expert consensus, evidence summaries, systematic reviews, and recommended practices, covering the period from January 1, 2018 to June 1, 2023. Two researchers trained in evidence-based nursing independently evaluated the quality of the literature and extracted and integrated the evidence.Results:A total of 23 articles were included, comprising two clinical decisions, one best practice, four guidelines, 13 systematic reviews, and three recommended practices. Ultimately, 18 pieces of best evidence were summarized from six aspects: the importance of fluid intake, intake volume, timing of intake, the relationship between different types of fluids and the risk of urinary calculi, intake recommendations, monitoring methods, and precautions.Conclusions:This study summarizes the best evidence for oral fluid intake management in adult patients with urinary calculi, which can provide reference for clinical nursing. When applying this evidence, it is essential to fully consider clinical circumstances and patient characteristics to reduce the recurrence rate of urinary calculi.

Objective To analyze the application value of transvaginal ultrasonography(TVS)combined with contrast-enhanced ultrasound(CEUS)in the diagnosis of cesarean scar pregnancy(CSP).Methods Sixty patients with CSP confirmed by operation and pathology admitted to the First Hospital of Jiaxing from January 2022 to November 2023 were retrospectively analyzed.TVS and CEUS were examined before operation.The detection rate and type diagnosis of CSP were compared between TVS and CEUS alone and combined diagnosis.The receiver operating characteristic(ROC)curve was used to analyze the efficiency of TVS and CEUS in identifying gestational cesarean scar pregnancy(GCSP).Results Among the 60 patients with CSP,53 patients with GCSP and 7 patients with mass cesarean scar pregnancy(MCSP)were confirmed by surgery and pathology.The detection rate of CSP by TVS combined with CEUS(98.33％)was significantly higher than that by TVS or CEUS(P＜0.05),and the detection rate of CSP by CEUS was significantly higher than that by TVS(P＜0.05).The detection rate of GCSP by TVS combined with CEUS(100.00％)was significantly higher than that by TVS or CEUS(P＜0.05).The area under the curve(AUC)of TVS combined with CEUS for identifying GCSP was the largest,which was 0.857.The sensitivity was 100.00％,and the specificity was 71.40％.The detection rate of MCSP by TVS combined with CEUS was significantly higher than that by TVS(P＜0.05).Conclusion TVS combined with CEUS can effectively improve the clinical detection rate of CSP,which is conducive to the diagnosis of CSP classification,and has important application value.

The development of information technology in the medical industry is accelerating the construction of 3-level rehabilitation networks centering on community-based rehabilitation, which is based on the Internet and in combination with the Internet of things(IOT). A municipal rehabilitation hospital cooperated with the health centers of sub-district communities in the city to build a remote rehabilitation network based on IOT technology, for rehabilitation training of community stroke patients. The two sides worked out a cooperation scheme on project management, designed and built a remote community rehabilitation management model. Under the remote monitoring and equipment data IOT, the medical team of the municipal rehabilitation hospital could formulate the therapeutic plan according to the immediately obtained relevant functional evaluation data, and the medical team of the community health service center was responsible for the implementation of the plan. Fifty-three patients in the experimental group received the training of remote lower limb intelligent feedback system based on IOT together with routine rehabilitation training. After 8 weeks of treatment, the functional evaluation data of the two groups were improved in varying degrees( P< 0.05), but the improvement of the experimental group was significantly better than that of the control group( P < 0.05). Remote rehabilitation under the construction path of remote rehabilitation network based on IOT technology could significantly promote the improvement of post-functional rehabilitation of community stroke patients. This study can provide reference for the construction of three-level remote rehabilitation networks based on IOT and the implementation of home-based remote rehabilitation therapy in the future.

Objective:To investigate the efficacy and feasibility of urethroplasty using inner prepuce graft combined with Orandi flap for the treatment of the obliterated penile urethral atresic stricture.Methods:From January 2016 to September 2019, the clinical data of 18 obliterated penile urethral stricture cases were analyzed retrospectively. All the patients were treated using inner prepuce flap combined with Orandi Flap. The average age of the patients was 62.1 years old (range 20-81 years old). Ten cases had suprapubic cystostomy before operation. The maximum flow rate was 1.6-6.2 ml/s, with an average of 4.2ml/s. The intubation general anesthesia and lithotomy position was used. The foreskin of penis was incised longitudinally. The urethra was exposed and the segment of stricture was opened longitudinally. The range of stricture length was measured with soft ruler, ranging from 2.0 to 7.5 cm, with an average of 5.0cm. After the fibrotic tissue was completely removed, the dorsal inner prepuce was incised with needed length and width for harvesting a free skin flap in order to transplant and reconstruct the dorsal urethral. The Orandi flap was used to cover the ventral urethra, and a F14-16 silicone catheter was retained. The length range of the inner prepuce graft was 2.0-7.5 cm, with an average of 5.1cm; the width was 1.2-1.8 cm, with an average of 1.4cm. The length of Orandi flap was 2.2-7.7 cm, with an average of 6.0cm; the width was 1.0-1.5 cm, with an average of 1.3 cm. The catheter was removed 3-4 weeks after operation. The patients were then followed up after 3, 6 and 12 months postoperatively and then with annual assessments for the symptoms, urinary flow rate, and urethrography or soft urethroscopy when necessary.Results:All of the 18 operations were completed successfully. The patients were followed up for 6-36 months, with an average of 22 months. There were 5 patients with terminal dripping, 4 patients with recurrent urinary tract infection within half a year after operation, and antibiotic treatment being effective. The quality of life scores at 3 months and 6 months after operation were 0.8 (0-2) and 0.6 (0-1), respectively, which were statistically significant compared with before operation ( P<0.001). Conclusions:The use of free inner prepuce flap combined with Orandi flap is an effective treatment for the obliterated penile urethral atresic stricture, especially for the patients who are unwilling or unsuitable to harvest the oral mucosa. It has the advantages of convenient harvesting and less complications.