Objective:To explore the effect of "Internet +" combined with multidisciplinary out of hospital management in hospital-home transitional period management of patients after lumbar internal fixation.Methods:From October 2021 to September 2022, convenience sampling was used to select 176 patients who underwent lumbar internal fixation at the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University. According to the admission time, patients enrolled from October 2021 to March 2022 were included in the control group, and patients enrolled from April to September 2022 were included in the observation group, with 88 cases in each group. The control group implemented routine out of hospital follow-up management, while the observation group implemented "Internet +" combined with multidisciplinary out of hospital management. After three months of intervention, the recovery of lumbar and back function [Oswestry Disability Index (ODI) and Macnab score], surgical efficacy (NaKa grading), nursing satisfaction, and readmission rate were compared between the two groups.Results:After three months, the ODI score of the observation group was lower than that of the control group, and the Macnab score was higher than that of the control group, the NaKa grading was better than that of the control group, with statistically significant differences ( P<0.05). In the observation group and control group, the total effective rate of surgery, nursing satisfaction, and readmission rate were 88.64% (78/88) vs. 67.05% (59/88), 94.32% (83/88) vs. 78.41% (69/88), 4.55% (4/88) vs. 17.05% (15/88), respectively. The total effective rate and nursing satisfaction of the observation group were higher than those of the control group, and the readmission rate was lower than that of the control group, with statistical differences ( P<0.05) . Conclusions:"Internet +" combined with multidisciplinary out of hospital management can effectively improve the recovery of lumbar function in hospital-home transitional period management of patients after lumbar internal fixation, enhance the surgical efficacy and nursing satisfaction, and reduce the readmission rate.

In many neurodegenerative diseases,eye movement is disrupted,which is a common and early characteris-tic of neurodegenerative diseases.Characterizing eye movement is important for the diagnosis of neurodegenerative disea-ses,helping to track disease progression and response to treatment.In recent years,eye tracking technology has been ap-plied to the assessment of cognitive function in patients with neurodegenerative diseases.Compared to traditional cognitive assessment methods,the technology has higher temporal and spatial resolution for sensitive quantification.Eye tracking da-ta confirms that executive dysfunction is common in Parkinson's disease and amyotrophic lateral sclerosis,while attention deficit is a characteristic of Alzheimer's disease and multiple sclerosis.Research using eye tracking to evaluate the cogni-tive function of epilepsy patients is still in its early stages,but this method has shown advantages.In this article,the appli-cation of eye tracking technology in neurodegenerative diseases is reviewed.

Objective:To investigate the changes of blood glucose and blood lipid in gestational diabetes mellitus (GDM) patients with different insulin sensitivity during pregnancy and the effect of non-drug intervention.Methods:Data of 240 pregnant women with GDM and 240 healthy pregnant women were collected from July 1 to September 1, 2023 in Shijing People′s Hospital in Baiyun District and other five hospital. The insulin sensitivity index (ISI) was calculated by homeostasis model assessment 2(HOMA2) model, according to the 25th percentile of ISI of normal pregnant women, GDM patients were divided into insulin sensitive group (group A) and insulin sensitive deficiency group (group B), and group A and group B were divided into two groups according to 36-week blood glucose control: group A1 with good blood glucose control (group A1 and group B1) and group A2 with bad blood glucose control (group A2 and group B2). The age, body mass index (BMI) before pregnancy, fasting plasma glucose (FPG), blood lipids and blood glycated hemoglobin (HbA 1c ) in the first trimester, blood glucose and blood lipids in the second trimester were compared at the 28th, 32nd and 36th weeks of gestation, the number of cases, blood glucose, blood lipids and non-drug intervention were measured. Results:There were 166 cases in group A and 74 cases in group B. Blood glucose and blood lipid were normal in early pregnancy. There was no significant difference in blood glucose between group A and group B during the second trimester. The levels of blood lipids were significantly higher than those during the first trimester, and the levels of triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) were significantly higher than those during the first trimester. The number of pregnant women in group A1 was significantly more than that in group A2 in the third trimester ( P = 0.01), and the number of pregnant women in group B1 was more than that in group B2 at 28 weeks ( P = 0.01). At 32 weeks, the number of pregnant women in group B1 and group B2 was similar ( P = 0.31). At 36 weeks, the number of pregnant women in group B1 was significantly lower than that in group B2 ( P = 0.01). In the third trimester of pregnancy, the levels of blood glucose in group B2 were higher than those in group A2 ( P<0.05). The levels of TG and LDL-C in group A2 and group B2 were higher than those in group A1 and group B1 respectively, high-density lipoprotein cholesterol (HDL-C) was lower than that in group A1 and group B1( P<0.05), and there was no significant difference in TC between group A2 and group A1 at 28 and 32 weeks ( P>0.05), but it was significantly higher at 36 weeks ( P = 0.01). In the third trimester of pregnancy, diet control was the most common (91.7%, 87.7%, 81.6%, respectively) in group A ( P>0.05). The proportions of diet-only and diet-plus exercise interventions were similar in group B1 at 28 weeks and 32 weeks (52.9% vs. 47.1%, 45.7% vs. 54.3%)( P = 0.072, 0.113). At the 36 weeks, the main intervention was diet combined with exercise (73.3%). In group B2, dietary intervention (69.6%, 71.8%, 69.5%) was the main cause of poor control of blood glucose. Conclusions:In GDM patients with insulin sensitivity deficiency, the blood glucose and blood lipids in the second trimester are obviously increased, and the abnormality in the third trimester is even greater.

Background and purpose:Human epidermal growth factor receptor 2(HER2)is closely associated with drug efficacy and prognosis in urothelial carcinoma(UC).HER2 is a significant biomarker and therapeutic target in various tumors.In recent years,anti-HER2 antibody-drug conjugates have shown significant clinical efficacy in UC patients with HER2 overexpression.Therefore,an in-depth understanding of HER2 expression and its characteristics in Chinese UC patients is crucial to guide treatment decision-making,optimize treatment strategies and achieve personalized therapy.This study aimed to thoroughly investigate correlation of HER2 expression and clinicopathological characteristics in Chinese patients with UC.Methods:This study was a multicenter study that retrospectively included UC patients from urology departments of 8 tertiary hospitals in 5 geographical regions of China(North China,East China,South China,Central China and Northwest)whose tissue samples were collected from January 2023 to March 2024.Inclusion criteria:① age above 18 years;② UC diagnosed by histopathological or cytological examination;③ complete results of HER2 expression detection using immunohistochemistry(IHC)in the primary tumor site were required.Exclusion criteria:① diagnosed patients with tumors in other parts of the body;② physicians evaluated other situations that were not suitable for inclusion in this study.IHC results for HER2 expression and clinicopathological data were collected.HER2 expression was determined according to the criteria outlined in"Clinical pathological expert consensus on HER2 testing in urothelial carcinoma in China",with HER2 2+and 3+defined as HER2 overexpression.The HER2 expression and clinicopathological features were analyzed.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethical number:2301268-12)and was registered at China Clinical Trial Registry(registration number:ChiCTR2300069746).Results:A total of 1054 patients with UC were included.Most of the tumors were bladder UC(n=807,76.6%).The mean age of patients was(66.8±10.5)years,and the majority were male(78.5%).The HER2 overexpression rate was 58.4%(n=616),with an additional 23%of patients having HER2 1+expression(n=242),and a small proportion exhibiting negative HER2 expression(n=196,18.6%).HER2 expression was significantly associated with various clinical and pathological characteristics such as Eastern Cooperative Oncology Group(ECOG)performance status,history of cardiovascular disease,history of metabolic disorders,smoking,UC disease location,differentiation grade,pathological type,and tumor stage.Conclusion:Retrospective analysis of multi-center data shows that HER2 expression is frequently observed in Chinese UC patients,with an overexpression rate of up to 58.4%.Furthermore,HER2 expression is closely associated with various clinical and pathological features of UC patients.This study underscores the critical importance of accurately assessing HER2 expression in UC patient to guide personalized therapies.

Congenital entropion, an abnormal condition in which the eyelids roll inward, with the eyelashes losing their normal angulation and tilting toward the eye, especially in the lower eyelids and inner canthus, often occurs in infants and young children. Congenital entropion may lead to corneal epithelial abrasion, inflammation and ulcer, which may affect the function of the eye if not treated in time. Early surgical intervention is helpful to the health of children's eyes. The purpose of surgery is to change the structure of eyelid and weaken the force of entropion, thus improving the symptoms and corneal astigmatism. At present, there are many surgical treatments for congenital entropion. In this paper, the advantages, disadvantages and indications of these treatments are analyzed and summarized, providing a reference for clinical practice.

Objective To analyze the distribution characteristics of 9 hypertension drug related gene polymorphisms in the population of essential hypertension(EH)in Xi'an area,providing an objective basis for personalized treatment.Methods A total of 306 EH patients who visited the Shaanxi Provincial Armed Police Force Hospital from January 2022 to December 2023 were selected as the research subjects.The PCR melting curve method was used to detect 9 hypertension drug related gene polymorphisms,their genotype and allele distribution frequency were analyzed,and the correlations of gene polymorphism among patients of different genders,ages,and hypertension grading groups were compared.Results Among 306 patients,the distribution frequencies of each gene were consistent with Hardy Weinberg equilibrium(x2=0.153～2.941,all P＞0.05).Mutation rates of various gene were as follows:SLCO1B1 c.388A＞G,ADRB1 c.1165G＞C,MTHFR C677T,ADD1 c.1378G＞T,CYP2D6 c.100C＞T,ACE I/D,CYP3A5 c.806-4288C＞T,SLCO1B1 c.521T＞C,AGTR1 c.1166A＞C and CYP2C9 c.1075A＞C were 77.29％,73.20％,56.54％,48.37％,50.82％,35.13％,29.41％,11.76％,7.68％and 3.43％,respectively,and CYP2C9 c.403C＞T had no mutation.Comparing with patients of different genders,the mutation rate of SLCO1B1 c.388A＞G genotype and allele mutations in male group were higher than those in the female group(x2=5.221,8.237),the mutation rate of CYP2D6 c.100C＞T genotype and allele in the female group were higher than those in the male group(x2=5.093,9.661),the mutation rate of ACE I/D allele in the male group was higher than that in the female group(x2=6.118,8.032),with significant differences(all P＜0.05).The mutation rates of CYP2C9 c.1075A＞C,SLCO1B1 c.388A＞G,CYP2D6 c.100C＞T genotypes and alleles in the middle-aged and young age group were higher than those in the elderly group,and the differences were statistically significant(x2=11.683,10.243;9.003,9.803;10.617,9.931,all P＜0.05).There was no significant difference in the comparison of other genotypes and alleles among different gender and age groups and in the frequency of genotype and allele mutations among different hypertension grading groups(x2=1.321～7.733,1.031～5.198,all P＞0.05).Conclusion The distribution of gene polymorphisms related to antihypertensive drugs in the Xi'an area was related to the gender and age of EH patients.Thus,the genotype testing of antihypertensive drugs may have important guiding significance for personalized medication treatment of EH patients.

N6-methyladenosine(m6A)is produced by methylation of the 6th nitrogen atom of ade-nine.The m6A methylation modification is the most common internal modification of RNA,and the modifica-tion process mainly relies on m6A-related enzymes,including methyltransferases,demethylases and binding proteins.The core structure of the methyltransferase complex(MTC)is methyltransferase-like 3(METTL3).The pathogenesis of osteoarthritis(OA)is intricate and complex,and various factors interact with each other.This paper summarizes the mechanism of action of m6A and related enzymes,and elaborates the pathogenesis of os-teoarthritis from the aspects of chondrocytes,proteases,cytokines and signaling pathways,emphatically intro-duces the regulatory role of METTL3 on OA in m6A methylated modification.The aim is to provide new per-spectives on the pathogenesis of osteoarthritis in order to provide new ideas and approaches for the treatment of osteoarthritis.

Objective:To translate Propensity to Achieve Healthy Lifestyle Scale (PAHLS) into Chinese and test its reliability and validity in patients with hypertension to provide the reliable assessment tool for medical staff to evaluate the propensity to achieve healthy lifestyle in hypertensive patients.Methods:This was a cross-sectional study. The original scale was translated according to Brislin model. After expert correction, cultural adjustment and pre-investigation, the items for Chinese version of PAHLS were determined. From February to May 2023, 400 patients with hypertension were selected as the participants from Tianjin Hebei District Tiedong Road Street Community Healthcare Center, Tianjin Dongli District Junliang Cheng Hospital by convenience sampling method. Critical ration and correlation analysis were used for item analysis. Content validity, exploratory factor analysis and confirmatory factor analysis were used to evaluate the validity of the Chinese version of PAHLS. Cronbach′s α coefficient and split-half reliability were used to evaluate the reliability of the scale. Results:A total of 400 patients were included in this study ultimately, aged (71.69 ± 7.25) years old, 177 males and 223 females. The Chinese version of the PAHLS included 6 items, and the results of item analysis showed that the content of each item was highly consistent with that of overall scale. The content validity indexes of the Chinese version of PAHLS at both the scale level and item level were 1. Only one factor was extracted based on exploratory factor analysis, with a cumulative variance contribution rate of 72.24%. Confirmatory factor analysis indicated a good fit, with the fitting indexes of χ2/ df=0.53, root mean square error of approximation (RMSEA)<0.01, root of mean square residual (RMR)=0.02, goodness-of-fit index (GFI)=1.00, comparative fit index (CFI)=1.00, normed fit index (NFI)=1.00, adjust goodness-of-fit index (AGFI)=0.98, incremental fit index (IFI)=1.00, Tucker-Lewis index (TLI)=1.01, Convergent validity: composite reliability (CR)=0.86 and average vriance extracted (AVE)=0.53. The overall Cronbach′s α coefficient of the scale was 0.91 and Cronbach′s α coefficients of item level were from 0.87 to 0.91, with split-half reliability value of 0.89. Conclusions:The Chinese version of the PAHLS has good reliability and validity, which can be used by medical staff to evaluate the propensity to achieve healthy lifestyle in hypertensive patients under Chinese cultural background, to increase understanding of decision-making on behavioral change in hypertensive patients and promote medical staff to jointly develop behavioral change plans with hypertensive patients.

Objective To investigate the impact of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack (TIA). Methods A total of 366 patients with acute mild ischemic stroke or moderate-high risk TIA who carried CYP2C19 loss-of-function alleles were included in the study. Baseline data were collected at admission, and clinical outcomes were collected within 3 months post-onset (primary outcomes: stroke recurrences within 3 months post-onset; secondary outcomes: composite outcome of stroke recurrence or death within 3 months post-onset, vascular events, and quality of life within 3 months). Kaplan-Meier method was used to plot the cumulative incidence curve of outcomes. Multivariate Cox proportional hazards model and multivariate Logistic regression model were used to evaluate the relationship between overweight and clinical outcomes within 3 months post-onset in patientswith ischemic stroke or TIA. The integrated discrimination improvement index (IDI) and net reclassification improvement index (NRI) were calculated to assess the predictive value of adding body mass index (BMI, whether overweight or not) based on traditional models for predicting the prognosis of acute ischemic stroke or TIA. Results After 3 months of follow-up, 28 patients had stroke recurrence, 1 patient died, and 31 patients had vascular events. The Kaplan-Meier cumulative incidence curve showed that the cumulative incidences of stroke recurrence, stroke recurrence or death, and vascular events after 3 months of onset were lower in overweight patients compared with non-overweight patients (Log-rank P < 0.05). Multivariate analysis showed that compared with non-overweight patients, overweight patients had significantly reduced risks of stroke recurrence within 3 months (HR=0.24; 95%CI, 0.08 to 0.71), composite outcome of stroke recurrence or death (HR=0.24; 95%CI, 0.08 to 0.69), and vascular events (HR=0.22; 95%CI, 0.07 to 0.63), and significantly improved quality of life within 3 months (OR=0.39; 95%CI, 0.20 to 0.76). The IDI and NRI calculations showed that compared with traditional models, the new model adding BMI (whether overweight) had significantly improved predictive ability for the prognosis of acute ischemic stroke or TIA. Conclusion Overweight may be a protective factor for the prognosis of TIA patients with acute mild ischemic stroke or moderate-high risk who carry CYP2C19 loss-of-function alleles. Compared with non-overweight patients, overweight patients have reduced risks of stroke recurrence, composite outcome of stroke recurrence or death, and vascular events within 3 months post-onset, and improved quality of life within 3 months post-onset.

Growth hormone deficiency (GHD) has become a serious healthcare burden, and presents a huge impact on the physical and mental health of patients. Here, we developed an actively separated microneedle patch (PAA/NaHCO₃-Silk MN) based on silk protein for sustained release of recombinant human growth hormone (rhGH). Silk protein, as a friendly carrier material for proteins, could be constructed in mild full-water conditions and ensure the activity of rhGH. After manually pressing PAA/NaHCO₃-Silk MN patch to skin for 1 min, active separation is achieved by absorbing the interstitial fluid (ISF) to trigger HCO₃ ^‒ in the active backing layer to produce carbon dioxide gas (CO₂). In rats, the MN patch could maintain the sustained release of rhGH for more than 7 days, and produce similar effects as daily subcutaneous (S.C.) injections of rhGH in promoting height and weight with well tolerated. Moreover, the PAA/NaHCO₃-Silk MN patch with the potential of painless self-administration, does not require cold chain transportation and storage possess great economic benefits. Overall, the PAA/NaHCO₃-Silk MN patch can significantly improve patient compliance and increase the availability of drugs, meet current unmet clinical needs, improve clinical treatment effects of GHD patients.