OBJECTIVE: To observe the effect of acupuncture at back-shu points on patients with post-stroke tracheotomy on the basis of extracorporeal diaphragmatic pacing (EDP) combined with conventional acupuncture. METHODS: A total of 64 patients with post-stroke tracheotomy were randomly divided into an experiment group (32 cases, 2 cases dropped out) and a control group (32 cases, 2 cases dropped out). The control group received EDP combined with conventional acupuncture, acupuncture was applied at Baihui (GV20), Zhongwan (CV12) and bilateral Fengchi (GB20), Quchi (LI11), Hegu (LI4), Neiguan (PC6), Xuehai (SP10) , Yinlingquan (SP9), Sanyinjiao (SP6), Zusanli (ST36), 30 min each time. The experiment group was treated with acupuncture at bilateral Feishu (BL13), Pishu (BL20), Shenshu (BL23) on the basis of the treatment in the control group, 30 min each time. Acupuncture in both groups was given once a day, 5 days a week for 4 weeks. Before and after treatment, the pulmonary function (forced vital capacity [FVC], first second forced expiratory volume [FEV₁], peak expiratory flow [PEF], maximal inspiratory pressure [MIP], maximal expiratory pressure [MEP]), diaphragmatic thickening fraction (DTF), diaphragm excursion (DE), postural assessment scale for stroke patients (PASS) score and Berg balance scale (BBS) score were observed in the two groups. The extubation success rate was recorded in the two groups. RESULTS: After treatment, the FVC, FEV₁, PEF, MIP and MEP in the two groups were increased compared with those before treatment (P<0.001), and above indexes in the experiment group were higher than those in the control group (P<0.001, P<0.01). After treatment, the DTF and DE in the two groups were increased compared with those before treatment (P<0.001), the DE in the experiment group was higher than that in the control group (P<0.001). After treatment, the PASS and BBS scores in the two groups were increased compared with those before treatment (P<0.001), and the BBS score in the experiment group was higher than that in the control group (P<0.001). The extubation success rate of the experiment group was 73.3% (22/30), which was higher than 46.7% (14/30) in the control group (P<0.05). CONCLUSION On the basis of EDP combined with conventional acupuncture, acupuncture at back-shu points can improve the pulmonary function, respiratory muscle strength, trunk control and balance abilities in patients with post-stroke tracheotomy, and increase the extubation success rate.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Aged ; Stroke/complications* ; Acupuncture Points ; Tracheotomy ; Adult ; Airway Extubation ; Treatment Outcome

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

Heatstroke, a life-threatening illness, poses a significant risk to human health, particularly in high-temperature and high-humidity environments. Timely and effective on-site management is critical for improving patient survival and prognosis. Rapid recognition, rapid assessment, and rapid cooling are the cornerstones of pre-hospital care. However, the absence of a standardized protocol for pre-hospital management of heatstroke has impeded the efficacy of treatment. This consensus, initiated by the Expert Group on Heatstroke Prevention of the People's Liberation Army, signifies a collaborative endeavor involving emergency medical personnel, nurses, and administrators from pre-hospital care, emergency departments, and intensive care units in both military and civilian domains. By systematically reviewing evidence-based medicine and clinical expertise in heatstroke prevention, on-site and in-transit care, as well as early treatment in emergency settings, the group has formulated the Expert consensus on pre-hospital emergency management of heatstroke (2024) after extensive discussions and iterative recommendations, which serve as a scientific and standardized framework for pre-hospital heatstroke emergency care. The consensus underscores the pivotal role of enhancing public awareness regarding heatstroke prevention and augmenting the rates of rapid recognition and rapid cooling for effective on-site heatstroke management. In high-risk industries, regions, or seasons for heatstroke, developing scientifically sound plans and conducting practical training can provide effective safety measures. Emergency personnel should undergo specialized training and assessments in knowledge and skills, ambulances should be equipped with effective cooling devices, and hospitals must maintain comprehensive emergency response capabilities. It is recommended to establish a regional heatstroke treatment network to optimize the allocation of emergency resources and streamline processes, thereby improving treatment outcomes and response times.
Heat Stroke/prevention & control* ; Humans ; Emergency Medical Services ; Consensus

Objective:To evaluate the effect of accelerated rehabilitation surgery (ERAS) under diagnosis-intervention packet (DIP) in patients with early cancer of digestive tract undergoing endoscopic submucosal dissection (ESD).Methods:The 64 patients with early cancer of digestive tract treated with ESD in the Gastroenterology Department of the Second People′s Hospital of Jiaozuo were selected by randomized controlled trial and convenient sampling method. According to random number table method, they were divided into routine group and observation group, 32 patients in each group. All patients in the 2 groups paid their medical expenses by DIP method, the routine group was treated with traditional perioperative nursing, and the observation group was treated with ERAS perioperative management mode. The postoperative complication rate, length of hospital stay, DIP allocation ratio, and patient satisfaction with nursing were compared between the two groups.Results:There were 16 men and women in the routine group, 14 men and 18 women in the observation group.After intervention, the incidence of postoperative complications was 21.88% (7/32) in the routine group and 3.12% (1/32) in the observation group, and the difference between the two groups was statistically significant ( χ2=5.14, P<0.05). The length of stay was (10.93 ± 2.87) d in the routine group and (9.01 ± 1.53) d in the observation group, and the difference between the two groups was statistically significant ( t=4.13, P<0.05). The average hospitalization expenses per case was (20 108.23 ± 6 495.49) yuan in the routine group and (18 589.03 ± 4 439.46) yuan in the observation group, and the difference between the two groups was statistically significant ( t=20.57, P<0.05). The DIP allocation ratio of the observation group was 87.98% (303 419.26/344 872.99), and that of the routine group was 69.33% (244 864.99/353 187.65), and the difference between the two groups was statistically significant ( χ2=4.81, P<0.05). The satisfaction of the observation group was 96.88% (31/32) and the routine group was 78.13% (25/32), and the difference between the two groups was statistically significant ( χ2=5.14, P<0.05). Conclusions:The accelerated rehabilitation surgical nursing can effectively reduce the postoperative complications, the average length of stay, the average hospitalization expenses per case under DIP in patients with early cancer of digestive tract treated by ESD, improve the DIP allocation ratio of ESD diseases and the patient′s nursing satisfaction, which reflects the value of nursing work and can be applied to the nursing management of other surgical diseases.

Objective To investigate the effect of vitamin B6(VB6)on vascular endothelial injury of atherosclerosis(AS)mice and its mechanism.Methods Thirty-six ApoE-/-mice were randomly divided into control group,AS group,VB6 group,AS+LiCl group,AS+VB6 group and AS+VB6+LiCl group,with 6 mice in each group.The mice in the AS group,AS+LiCl group,AS+VB6 group and AS+VB6+LiCl group were fed with high-fat diet for 12 weeks to establish the AS model;the mice in the control group and VB6 group were given regular diet and normal drinking water for 12 weeks.After 12 weeks,the mice in the control group were given conventional diet and the same volume of physiological saline as the VB6 group daily by gavage;the mice in the VB6 group were given routine diet and VB6(50 mg·kg-1)by gavage daily;the mice in the AS+LiCl group were given high-fat diet continuously and LiCl(1 mg·kg-1)by gavage daily;the mice in the AS+VB6 group were given high-fat diet continuously and VB6(50 mg·kg-1)by gavage daily;the mice in the AS+VB6+LiCl group were given high-fat diet continuously and VB6(50 mg·kg-1),LiCl(1 mg·kg-1)by gavage daily;all mice were intervened for 4 weeks.After intervention,the serum nitric oxide(NO),malondialdehyde(MD A)levels and superoxide dismutase(SOD)activity of mice in each group were measured by enzyme linked immunosorbent assay.Hematoxylin-eosin staining was used to observe the morphology of thoracic aortic tissue of mice in each group and the percentage of AS plaque area to total vascular area was calculated.The vasodilatation rate of thoracic aorta was detected by isolated vascular ring experiment.The expression of sodium/hydrogen exchanger 1(NHE1)protein in thoracic aorta was detected by immunohistochemistry.Results Compared with the control group,the NO level and SOD activity in the serum of mice in the AS group decreased,while the MDA level increased(P＜0.05);there was no significant difference in the NO,MDA levels and SOD activity in the serum of mice between the VB6 group and the control group(P＞0.05).Compared with the AS group,the serum NO level and SOD activity of mice in the AS+VB6 group increased,while the MDA level decreased(P＜0.05);there was no significant difference in serum NO,MDA levels and SOD activity of mice between the AS+LiCl group,AS+VB6+LiCl group and AS group(P＞0.05).Compared with the AS+VB6 group,the serum NO level and SOD activity of mice in the AS+VB6+LiCl group decreased,while the MDA level increased(P＜0.05).The percentage of AS plaque area to total vascular area of mice in the AS group was significantly higher than that in the control group(P＜0.05);there was no significant difference in the percentage of AS plaque area to total vascular area of mice among the VB6 group and the control group(P＜0.05).The percentage of AS plaque area to total vascular area of mice in the AS+VB6 group was significantly lower than that in the AS group(P＜0.05);there was no significant difference in the percentage of AS plaque area to total vascular area of mice between the AS+LiCl group,AS+VB6+LiCl group and AS group(P＜0.05).The percentage of AS plaque area to total vascular area of mice in the AS+VB6+LiCl group was significantly higher than that in the AS+VB6 group(P＜0.05).In the control group,the vascular endothelium of mice was smooth with orderly arrangement of cells;in the AS group,AS+LiCl group and AS+VB6+LiCl group,the tissue structure of vascular of mice was disordered and the vascular endothelium was rough;in the VB6 group and AS+VB6 group,the vascular wall structure of mice was normal,the vascular endothelium was smooth,and the cells were arranged orderly.The vasodilatation rate of thoracic aorta of mice induced by acetylcholine(Ach)in the AS group was significantly lower than that in the control group(P＜0.05);there was no significant difference in the vasodilatation rate of thoracic aorta of mice induced by Ach between the VB6 group and the control group(P＞0.05).The vasodilatation rate of thoracic aorta of mice induced by Ach in the AS+VB6 group was significantly lower than that in the AS group(P＜0.05);there was no significant difference in the vasodilatation rate of thoracic aorta of mice induced by Ach between AS+LiCl group,AS+VB6+LiCl group and AS group(P＞0.05).The vasodilatation rate of thoracic aorta of mice induced by Ach in the AS+VB6+LiCl group was significantly higher than that in the AS+VB6 group(P＜0.05).There was no significant difference in the vasodilatation rate of thoracic aorta of mice induced by sodium nitroprusside among the six groups(P＞0.05).The percentage of NHE1 expression in the thoracic aorta of mice in the AS group was significantly higher than that in the control group(P＜0.05);there was no significant difference in the percentage of NHE1 expression in the thoracic aorta of mice between the VB6 group and the control group(P＞0.05).The percentage of NHE1 expression in the thoracic aorta of mice in the AS+VB6 group was significantly lower than that in the AS group(P＜0.05);there was no significant difference in the percentage of NHE1 expression in the thoracic aorta of mice among the AS+LiCl group,AS+VB6+LiCl group and the AS group(P＞0.05).The percentage of NHE1 expression in the thoracic aorta of mice in the AS+VB6+LiCl group was significantly higher than that in the AS+VB6 group(P＜0.05).Conclusion VB6 can improve vascular endothelial injury in AS mice via inhibiting the expression of NHE1 protein.

Objective To investigate the effect and mechanism of cinobufotalin in inhibiting hepatocellular carcinoma(HCC)metastasis by regulating epithelial-mesenchymal transition(EMT).Methods A total of 36 male BALB/c nude mice,aged 6 weeks,were given injection of MHCC97H cells via the caudal vein to establish a model of HCC lung metastasis,and then the mice were randomly divided into high-and low-dose cinobufotalin groups and control group.Since the day of modeling,the mice in the high-and low-dose cinobufotalin groups were given intraperitoneal injection of cinobufotalin at a dose of 120 μL/kg and 60 μL/kg,respectively,and those in the control group were given intraperitoneal injection of normal saline,twice a week.After 8 weeks,HE staining was performed for lung tissue to measure the lung metastasis rate of HCC.MHCC97H cells were treated with high-dose(2.5 μL/mL)or low-dose(5 μL/mL)cinobufotalin for 24 hours,and wound healing assay,RT-PCR,and Western blot were used to measure cell migration ability and the expression of EMT-related molecules.MHCC97H cells were induced in a simulated hypoxic environment with CoCl2 incubation,with high-and low-dose cinobufotalin added for intervention,and wound healing assay and Western blot were used to investigate the effect of cinobufotalin on cell migration ability and EMT induced by hypoxia.Transcriptome analysis was used to investigate the effect mechanism of cinobufotalin on MHCC97H cells,and Western blot was used to observe the effect of cinobufotalin on the expression levels of protein kinase B(AKT)and phosphorylated AKT(P-AKT)in MHCC97H cells.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the independent-samples t test was used for comparison of categorical data between two groups.Results Compared with the control group,the cinobufotalin group had a significant reduction in the lung metastasis rate of HCC.Compared with the control group,cinobufotalin intervention reduced the wound healing rate of MHCC97H cells,upregulated the expression of epithelial-type molecules(t=2.860,P<0.05),and downregulated the expression of EMT transcription factors(EMT-TFs)and mesenchymal molecules(t=3.545,2.022,2.852,and 2.341,all P<0.05).Hypoxia induction upregulated the wound healing rate of MHCC97H cells and the expression levels of mesenchymal molecules and EMT-TFs(P<0.05),and cinobufotalin intervention reversed EMT change and inhibited wound healing(P<0.05).The transcriptome analysis of MHCC97H cells showed significant gene differences between the cinobufotalin group and the control group,and cinobufotalin mainly affected the expression of genes associated with tumor,metabolism,immunity,and signal transduction,with the largest number of differentially expressed genes in the AKT signal transduction pathway.Further measurement showed that cinobufotalin intervention downregulated the expression levels of AKT,P-AKT,and P-AKT/AKT in MHCC97H cells(t=2.434,3.401,and 2.258,all P<0.05).Conclusion Cinobufotalin can inhibit the metastasis of HCC,especially hypoxia-induced HCC metastasis,and regulation of EMT mediated by the AKT signal transduction pathway in HCC cells might be one of its mechanisms of action.

Objective:To compare the pregnancy outcomes of luteal phase and follicular phase progestin-primed ovarian stimulation protocol with clomiphene citrate supplementation(LPPOS+CC and FPPOS+CC)in young women with diminished ovarian reserve(DOR).Methods:A total of 483 women aged≤35 years with DOR,who underwent in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)/embryo transfer(ET)with controlled ovarian stimulation using LPPOS+CC(n=257)or FPPOS+CC(n=226)protocols during June 2018 and December 2021 at the First Affiliated Hospital of Wenzhou Medical University,were included in this retrospective study.The baseline characteristics,superovulation results,laboratory related indicators between the two groups,and the pregnancy outcomes of women who achieved at least one high-quality cleavage-stage embryo or good-morphology blastocyst were compared between the two groups.Results:No statistically significant differences were identified between the groups with respect to age,duration of infertility,proportion of secondary infertility,previous failed cycles,body mass index,anti-Müllerian hormone,antral follicle count,basal luteinizing hormone level,basal progesterone level,number of oocytes retrieved,oocyte maturation rate,high-quality cleavage-stage embryo cycle rate,the percentage of women with profound pituitary suppression,live birth rate and preterm birth rate(all P＞0.05).The LH levels on the day of trigger[4.0(2.7,5.3)vs.5.1(3.2,7.2)IU/L],the percentage of women with LH levels of＞10 IU/L on the trigger day(3.13%vs.10.67%),and the two pronucleus(2PN)rate of ICSI oocytes(72.16%vs.79.56%)were significantly lower in the LPPOS+CC group than those in the FPPOS+CC group(P＜0.05 or P＜0.01).The duration of stimulation[11(9,12)vs.9(8,11)d],the consumption of total gonadotropin[2213(1650,2700)vs.2000(1575,2325)IU],the progesterone levels on the day of trigger[1.3(0.8,2.9)vs.0.9(0.6,1.2)ng/mL],the clinical pregnancy rate[61.88%vs.46.84%],and implantation rate[42.20%vs.31.07%]in the LPPOS+CC group were significantly higher than those in the FPPOS+CC group(all P＜0.01).Conclusion:Compared to FPPOS+CC,the LPPOS+CC protocol appears to have better pregnancy outcomes for young women with DOR undergoing IVF/ICSI-ET.

Objective To evaluate the performance of the Quality of Life Instrument for Chronic Dis-ease Nephrotic Syndrome [QLICD-NS(V2.0)] in patients with nephrotic syndrome.Methods A total of 203 patients with nephrotic syndrome (NS) diagnosed in the Department of Nephrology,Affiliated Hospital of Guangdong Medical University from March 2021 to November 2021 were selected for QLICD-NS(V2.0) eval-uation,and the evaluation methods were generalization theory (GT) and item response theory (IRT).The dif-ficulty,discrimination coefficient and information amount of each item were obtained by using Multilog 7.0 software to analyze the grade response model (GRM) of IRT.Results The results of GT showed that the contribution ratio of the global total score in the four domains of QLICD-NS(V2.0) scale was evenly distribu-ted,and the generalization coefficient of the four domains was greater than 0.50.Except for social function,the variance component of the participants in the other three domains were greater than the item variance compo-nent,and the reliability index of each domain was greater than 0.50.The results of IRT showed that the dis-crimination degree of QLICD-NS(V2.0) scale was 0.82.Except for items TNS7 and TNS8,the difficulty coef-ficients of the other items ranged from -3 to 3 and increase monotonically.Conclusion The QLICD-NS (V2.0) scale has good reliability in physiological function and psychological function,and is acceptable in so-cial field and special function.The QLICD-NS(V2.0) scale developed in this study has good performance.

OBJECTIVE To explore the epidemiological characteristics,symptoms and CT features of fungal ball sinusitis.METHODS A retrospective analysis was conducted on the clinical data of 182 patients with pathologically confirmed fungal ball sinusitis,in which demographic characteristics,sinus involvement,and imaging manifestations were analyzed.RESULTS Unilateral maxillary sinus involvement was predominant(144 cases,79.1%).Head and facial pain(83 cases,45.6%)was the most common clinical symptom.In terms of CT imaging,the total incidence rate of calcification and bone hyperplasia is 93.4%(170/182);There was no statistically significant difference in the occurrence of bone hyperplasia between different sinuses caused by fungal infections(P>0.05).The probability of fungal maxillary sinusitis and fungal sphenoid sinusitis affecting the nasal septum is the same(P>0.05).The presence or absence of high-density shadows in CT imaging does not increase the probability of pathological detection of Aspergillus(P>0.05).CONCLUSION The probability of bone hyperplasia and accumulation of nasal septum bone in different sinuses infected with fungal balls is the same.

Objective To explore the influencing factors of rational perioperative drug use,and to establish a rationality prediction model based on machine learning to assist pharmacists in prescription review.Methods A retrospective analysis was conducted on the perioperative prescription data of neurosurgery patients from a tertiary hospital and a central hospital in Shanxi Province between March 2021 and March 2023.Univariate analysis and multivariate Logistic regression were initially used to identify factors influencing rational drug use,followed by Lasso regression and multicollinearity analysis to select important variables.The data was split into a training set and test set at a ratio of 7∶3,and decision tree(DT),multi-layer perceptron(MLP),extreme gradient boosting(XGBoost),support vector machine(SVM),and random forest(RF)learning models were constructed.Results A total of 1 500 prescriptions were included,of which 668 were classified as rational and 832 as irrational.In both the training and test sets,the AUC values of the DT,XGBoost,and RF models exceeded 0.9.The DT model showed the highest sensitivity(0.81),while the RF model demonstrated the highest specificity(0.90).In the RF model,the number of comorbidities,preoperative waiting time,total hospitalization cost,prescribing physician's title,and adverse reaction occurrence negatively impacted prescription rationality,whereas the number of drugs,age,and administration route positively influenced rationality.Conclusion The machine learning-based rational drug use prediction model demonstrates strong predictive performance,effectively assisting pharmacists in prescription review and helping to reduce the incidence of irrational drug use.