OBJECTIVE: To investigate the diagnostic efficacy of ^99mTc-MDP three-phase bone scintigraphy (TPBS) combined with C-reactive protein (CRP) for periprosthetic joint infection (PJI). METHODS: The clinical data of 198 patients who underwent revision surgery of artificial joint between January 2017 and January 2024 and received TPBS examination before surgery were retrospectively analyzed. There were 77 males and 121 females with an average age of 63.74 years ranging from 24 to 92 years. There were 90 cases of hip arthroplasty and 108 cases of knee arthroplasty. PJI was diagnosed according to the 2013 American Musculoskeletal Infection Society (MSIS) standard diagnostic criteria. The sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predict value (PPV) were calculated. The receiver operating characteristic (ROC) curve was used to compare the diagnostic performance of the three methods, and the area under curve (AUC) was used to evaluate the diagnostic performance. RESULTS: According to the 2013 MSIS criteria, 116 cases were diagnosed as PJI, and the remaining 82 cases were aseptic loosening. The cases of PJI diagnosed by TPBS, CRP, and TPBS-CRP were 125, 109, and 137 respectively, and the cases of aseptic loosening were 73, 89, and 61 respectively. The sensitivity, accuracy, NPV, and PPV of TPBS-CRP combination in the diagnosis of PJI were higher than those of TPBS and CRP, but the specificity was lower than that of TPBS and CRP. ROC curve analysis further showed that the AUC value of TPBS-CRP combination was better than that of TPBS and CRP. The severity of bone defect and the duration of symptoms in patients with false positive TPBS diagnosis were worse than those in patients with true negative TPBS diagnosis (P<0.05), but there was no significant difference in the survival time of prosthesis between the two groups (P>0.05). Among the patients diagnosed with PJI by TPBS, CRP, and TPBS-CRP, 49, 35, and 54 patients had received antibiotic treatment 2 weeks before diagnosis, respectively. There was no significant difference in the diagnostic accuracy of TPBS and TPBS-CRP before diagnosis between patients treated with and without antibiotics and those not treated (P>0.05). The diagnostic accuracy of antibiotic therapy before CRP diagnosis was significantly lower than that of untreated patients (P<0.05). CONCLUSION TPBS and CRP have limited specificity in differentiating PJI from aseptic loosening. The TPBS-CRP combination diagnostic method can synergize the local bone metabolic characteristics and systemic inflammatory response to achieve higher diagnostic accuracy, but caution should be exercised in patients with severe bone defects and longer symptom duration.
Humans ; Prosthesis-Related Infections/blood* ; Middle Aged ; Male ; Female ; Aged ; C-Reactive Protein/metabolism* ; Retrospective Studies ; Adult ; Radionuclide Imaging/methods* ; Arthroplasty, Replacement, Knee/adverse effects* ; Aged, 80 and over ; Technetium Tc 99m Medronate ; Arthroplasty, Replacement, Hip/adverse effects* ; Sensitivity and Specificity ; Knee Prosthesis/adverse effects* ; ROC Curve ; Reoperation ; Radiopharmaceuticals ; Young Adult

ObjectiveTo assess the microstructural involvement of gray matter in recovered COVID-19 patients using Synthetic MRI. MethodsThis study was conducted in 29 recovered COVID-19 patients， including severe group （SG， n=11） and ordinary group （OG， n=18）. Healthy volunteers matched by age， sex， BMI and years of education were selected as a healthy control group （HC=23 cases）. Each subject underwent synthetic MRI to generate quantitative T₁ and T₂ maps， and the T₁ and T₂ maps were segmented into 90 regions of interest （ROIs） using automatic anatomical labeling （AAL） mapping. T₁ and T₂ values for each ROI were obtained by averaging all voxels within the ROIs. The T₁ and T₂ values of the 90 brain regions between the three groups were compared. ResultsRelative to HC， the SG had significantly higher T2 values in bilateral orbital superior frontal gyrus， bilateral parahippocampal gyrus， bilateral putamen， bilateral middle temporal gyrus， bilateral Inferior temporal gyrus， left orbital superior frontal gyrus， left orbital inferior frontal gyrus， left gyrus rectus， left anterior cingulate and paracingulate gyri， right median cingulate and paracingulate gyri， left posterior cingulate gyrus， and left supramarginal gyrus （P＜0.05）； Relative to OG， SG showed significantly increased T₂ values in the left rectus gyrus， left parahippocampal gyrus， bilateral middle temporal gyrus， and bilateral inferior temporal gyrus （P＜0.05）. Relative to HC， the T₁ values of SG were significantly increased in bilateral orbital superior frontal gyrus， left rectus gyrus， left anterior cingulate and paracingulate gyri， right posterior cingulate gyrus， left parahippocampal gyrus， left lingual gyrus， left putamen， left thalamus（P＜0.05）； Relative to OG， the T₁ values of SG were significantly higher in the right posterior cingulate gyrus， right calcarine fissure and surrounding cortex， and left putamen （P＜0.05）. ConclusionsEven after recovering from COVID-19， patients may still have persistent or delayed damage to their brain gray matter structure， which is correlated with the severity of the condition. SyMRI can serve as a sensitive tool to assess the extent of microstructural damage to the central nervous system， aiding in early diagnosis of the disease.

Objective:To explore the assessment value of echocardiogram combined with serum high-sensitivity C-reactive protein(hs CRP)and N-terminal pro brain natriuretic peptide(NT proBNP)levels on cardiac function of patients with coronary heart failure.Methods:A total of 306 patients with coronary heart failure admitted to Beijing Daxing District People's Hospital from November 2021 to November 2022 were selected as the study group.Among of them,144 cases were grade Ⅱ,103 cases were grade Ⅲ and 59 cases were grade Ⅳ as the classification of New York Heart Association(NYHA)for cardiac function.A total of 108 healthy examinees who underwent physical examinations in our hospital during the same period were selected as the healthy control group.All examinees were classified as the NYHA for cardiac function,and left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF),peak ejection rate(PER)and peak filling rate(PFR)of them were measured by echocardiogram.The NT proBNP and hs CRP levels of all examinees were measured.Receiver operating characteristic(ROC)curve was used to analyze the values of single LVEDV,LVESV,LVEF,PER,PFR,hs CRP and NT-proBNP,and the combination of them.Results:LVEDV(122.69±18.24)ml and LVESV(70.79±10.03)ml of the study group were significantly higher than(92.27±15.22)ml and(33.16±7.22)ml of the healthy control group,and the LVEF(42.26±5.13)％,PER(2.49±0.22)EDV/s and PFR(1.79±0.26)EDV/s of the study group were significantly lower than(69.34±5.27)％,(3.56±0.27)EDV/s,and(2.59±0.23)EDV/s of the healthy control group,with statistical significances(t=15.526,35.837,46.828,40.825,28.302,P<0.05),respectively.The levels of hs CRP and NT proBNP of the study group were significantly higher than those of the healthy control group,with statistical significance(t=88.000,29.099,P<0.05),respectively.The LVEDV and LVESV of grade Ⅱ/Ⅲ patients were significantly lower than those of grade Ⅳ patients,while LVEF,PER and PFR of grade Ⅱ/Ⅲ patients were significantly higher than those of grade Ⅳ patients,with statistically significant differences(t=53.391,92.658,32.140,240.474,116.921,P<0.05),respectively.The levels of hs CRP and NT proBNP of grade Ⅱ/Ⅲ patients were significantly lower than those in grade Ⅳ patients,with statistical significance(t=41.037,5.955,P<0.05),respectively.The results of ROC curve analysis showed that the sensitivities of single LVEDV,LVESV,LVEF,PER,PFR,hs CRP,NT proBNP and the combined examination of them were respectively 45.00％,50.00％,70.00％,70.00％,75.00％,70.00％and 90.00％,and the specificities of them were respectively 76.70％,57.00％,82.60％,44.20％,58.10％,52.30％and 96.50％.The area under curve(AUC)values of LVEDV,LVESV,LVEF,PER,PFR,hs CRP,NT proBNP and the combined examination of them were 0.592(95％CI:0.441-0.743),0.615(95％CI:0.468-0.761),0.766(95％CI:0.634-0.899),0.717(95％CI:0.575-0.860),0.674(95％CI:0.536-0.812),0.734(95％CI:0.592-0.876),0.581(95％CI:0.469-0.694)and 0.978(95％CI:0.947-1.000),respectively.Conclusion:The serum hs CRP,NT proBNP levels and function parameters of left heart in patients with coronary heart failure have occurred corresponding changes,and the above indicators have higher assessment value for the heart function of coronary heart failure,and the value of combined assessment is higher.

Objective:To investigate the status quo and influencing factors of the somatization of depressive emotions among college students, in order to provide a theoretical basis for the reform of mental health education and the formulation of operable mental health counseling for college students.Methods:Totally 297 college students from two institutions of higher education in Heilongjiang Province were selected by convenience sampling and investigated with the College Student Depressive Emotion Somatization Questionnaire, Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF), and the Type D Personality Scale (DS14) .Results:The total score for the College Student Depressive Emotion Somatization Questionnaire among the 297 students was (28.49±8.07), and the total score for the ATSPPH-SF was (21.98±2.73). Multiple linear regression analysis showed that the influencing factors for the somatization of depressive emotions in college students were professional psychological help-seeking attitudes and whether they had a Type D personality ( P < 0.05) . Conclusions:During university education, there should be a focus on students' personality traits and the positivity of their attitudes toward seeking professional psychological help in order to mitigate the occurrence of adverse psychological issues such as symptoms of depressive somatization.

Objective To investigate the correlations of serum cyclic adenosine monophosphate-responsive element binding protein regulator of transcription coactivator 3 (CRTC3) and oxidative stress indicators with carotid atherosclerosis in patients with coronary heart disease (CHD). Methods A total of 154 CHD patients in the hospital from June 2021 to June 2023 were selected as study group and divided into mild, moderate, and severe atherosclerosis groups based on the degree of carotid atherosclerosis; another 154 healthy individuals with physical examinations in the same period were selected as control group. Pearson method was used to analyze the correlations of serum CRTC3 and oxidative stress indicators with carotid atherosclerosis indicators. Results Serum CRTC3 and malondialdehyde (MDA), carotid plaque area and intima-media thickness (IMT) in the study group were significantly higher than those in the control group, while the levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were significantly lower than those in the control group (P < 0.05). In the mild, moderate and severe atherosclerosis groups, serum CRTC3 and MDA levels, carotid plaque area, and IMT significantly gradually increased, while SOD and GSH-Px levels significantly gradually decreased (P < 0.05). Pearson correlation analysis showed that serum CRTC3 and MDA levels were positively correlated with carotid plaque area and IMT (P < 0.05), while SOD and GSH-Px were negatively correlated with carotid plaque area and IMT (P < 0.05). The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the combined diagnosis of severe carotid atherosclerosis by CRTC3, SOD, MDA and GSH-Px was 0.990 (95%CI, 0.982 to 0.998), with a sensitivity of 96.27% and a specificity of 76.28%. The diagnostic value of the combined application of these four indicators was significantly higher than that of each indicator alone (Z_{combined-CRTC3}=2.723, Z_combined-SOD=2.698, Z_combined-MDA=2.673, Z_{combined-GSH-Px}=2.803, P < 0.05). Conclusion The serum levels of CRTC3 and MDA are significantly increased while SOD and GSH-Px levels are significantly decreased in CHD patients. Both serum CRTC3 and oxidative stress levels are closely related to carotid atherosclerosis.

Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.

Objective To compare the diagnostic performance of PI-RADS v2.1 and PI-RADS v2 in the detection of clinically significant prostate cancer(csPCa) by Meta-analysis. Methods The major biomedical databases were searched (CNKI, CBM, Medline, and Embase) with the keywords "PIRADS v2.1" or "PI-RADS v2.1". The Quality Assessment of Diagnostic Accuracy Studies Tool v2 (QUADAS-2) was used to evaluate literature quality. Meta-analysis was performed using STATA17.0 and ReMan5.4 software. Forest plots were used to represent the sensitivity and specificity of PI-RADS v2.1 and PI-RADS v2 for each study. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were combined, and diagnostic performance was evaluated using asummary receiver operating characteristic curve (SROC). Subgroup analysis was performed on three covariables: tumor location, threshold, and the nationality of authors. Results A total of 12 studies were included, involving 3 158 patients and 3 243 lesions. Forall zones and the whole gland, PI-RADS v2.1 had a larger area under the SROC curve (AUC) for csPCa performance, compared with PI-RADS v2. Subgroup analysis: PI-RADS v2.1 also had a larger area under the SROC (AUC) to detect transitional zone csPCa. Different diagnostic thresholds: when a score of 4 was used for the threshold, PI-RADS v2.1 had the maximum area under SROC (AUC) for csPCa performance detection. Author nationality: Researches of PI-RADS v2.1 in Chinese authors had the largest area under the SROC (AUC) in detecting csPCa performance. Conclusion Compared with PI-RADS v2, the diagnostic performance of PI-RADS v2.1 in detecting csPCa is not obviously improved and overall specificity is still low.

Objective:To explore the status and influencing factors of participation in cardiac rehabilitation of cardiovascular nurses.Methods:This is a cross-sectional study. From January to February 2022, a total of 3 047 cardiovascular nurses in members of China Cardiovascular Health Alliance were selected as research objects by convenience sampling method. General data questionnaire and Cardiovascular Nurses Participated in the Cardiac Rehabilitation Questionnaire (CNPCRQ) were used to investigate cardiovascular nurses. Multiple linear regression analysis was used to investigate the influencing factors of participation in cardiac rehabilitation of cardiovascular nurses. A total of 3 047 questionnaires were distributed in this study, and 2 704 valid questionnaires were effectively received, with an effective recovery rate of 88.74%.Results:The total score of CNPCRQ of cardiovascular nurses was (93.23±31.58), which was at a moderate level. Multiple linear regression analysis results showed that age, education, professional title, hospital location, hospital level, position type and hospital type were the influencing factors of participation in cardiac rehabilitation of cardiovascular nurses.Conclusions:The status of participation in cardiac rehabilitation of cardiovascular nurses in China needs to be improved. Role and job content of cardiovascular nurses should be further clarified, and cardiac rehabilitation knowledge and skills training should be strengthened in the future, so as to promote the profession development of cardiac rehabilitation and improve patients' health outcomes.

Objective:To explore the effect of network learning environment on critical thinking ability of nursing undergraduates.Methods:From September 2021 to January 2022, a total of 84 nursing undergraduates in the third grade of Nursing School of Harbin Medical University were selected as the research objects. The Online Learning Environment Scale and the Chinese version of Critical Thinking Ability Scale were used to investigate.Results:The total score of Online Learning Environment Scale of 84 nursing undergraduates was (63.21±15.29) , and the Chinese version of Crital Thinking Ability Scale was (248.71±36.35) . The total score of Online Learning Environment Scale of nursing undergraduates was positively correlated with the total score of Chinese version of Critical Thinking Ability Scale of nursing undergraduates ( P<0.01) . The results of multiple linear regression analysis showed that the influencing factors of critical thinking ability of nursing undergraduates included family economic situation, whether they could receive free online database resources from schools, and online learning environment ( P<0.05) . Conclusions:The online learning environment for nursing undergraduates is at a moderate level. It is suggested that nursing undergraduates should optimize the content and form of online learning and provide targeted learning support resources so as to improve the critical thinking ability of nursing undergraduates.