Objective:To develop the Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus to inform the development of targeted interventions for caregivers.Methods:The first draft of the questionnaire was formed through literature analysis, group discussion, semi-structured interviews, Delphi expert consultation and pre-testing based on the theory of knowledge, attitude and practice. Convenience sampling was applied to select homebound elderly diabetic patients within the Shangcheng District of Hangzhou City from August to September 2022, and the questionnaire was subjected to item analysis, reliability test and exploratory factor analysis. Patients within Gongshu District of Hangzhou City were selected from October to November 2022 for questionnaire survey and validation factor analysis.Results:The questionnaire included 31 entries in three dimensions of knowledge, attitude, and practice. The content validity index was 0.96 at the questionnaire level and 0.83 to 1.00 at the entry level. The overall Cronbach's α coefficient for the questionnaire was 0.933, the folded reliability was 0.836, and the retest reliability was 0.913. The exploratory factor analysis cumulative variance contribution was 68.917% and the validation factor analysis showed a good model fit.Conclusions:The Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus is scientific and practical and can be used to investigate the hypoglycemia prevention knowledge, attitude and practice among homebound elderly diabetic patients.

Objective To explore the factors influencing the occurrence of sarcopenia following esophageal cancer surgery and to as-sess the association between skeletal muscle fat infiltration and postoperative sarcopenia.Methods The retrospective study analyzed clin-ical data from patients who underwent radical esophagectomy in the Department of Thoracic Surgery at the Second Hospital of Lanzhou Uni-versity between January 2020 and December 2022.Based on whether the postoperative loss of skeletal muscle area exceeded 10％,pa-tients were categorized into a sarcopenia group(n=50)and a non-sarcopenia group(n=69).General clinical information,periopera-tive data,and imaging findings were collected.Statistical analyses were performed using R version 3.1.4,and cutoff values were deter-mined by receiver operating characteristic(ROC)curve analysis.Results There were statistically significant differences between the sar-copenia and non-sarcopenia groups in terms of postoperative chemotherapy,lymphocyte count,skeletal muscle area,skeletal muscle in-dex,prognostic nutritional index,and intramuscular fat content(P＜0.05).At the level of the third lumbar vertebra,intramuscular fat content was significantly correlated with the rate of postoperative skeletal muscle loss(r=0.21,P＜0.05),but showed no correlation with the preoperative skeletal muscle area(r=-0.07,P=0.45).Multivariate Logistic regression analysis revealed that preoperative in-tramuscular fat content,skeletal muscle index,and postoperative chemotherapy were independent predictors of postoperative sarcopenia.ROC curve analysis indicated that a cutoff value of-0.647 for preoperative intramuscular fat content at the third lumbar vertebra provided the optimal predictive efficacy for postoperative sarcopenia in esophageal cancer patients[area under the curve(AUC)=0.630,sensitivi-ty=80.00％,specificity=47.80％].Conclusions The degree of skeletal muscle fat infiltration at the L3 level is significantly associat-ed with the development of postoperative sarcopenia in patients with esophageal cancer.Early nutritional support and rehabilitation training in patients with high fat infiltration may help prevent the occurrence of postoperative sarcopenia.

Objective To investigate the diversity and composition of gut fungi microbiota in patients with polycystic kidney disease(PKD)and its correlation with clinical indicators.Methods A total of 44 PKD patients,44 patients with non-polycystic chronic kidney disease(NPCKD)and 22 healthy controls(HC)admitted to our hospital from February 2023 to February 2024 were recruited.ITS1 DNA sequencing was applied to analyze the gut fungal composition.Bioinformatics analysis was used to compare the diversity and structural differences of fungi among the 3 groups.Pearson correlation analysis was performed to analyze the relationship between gut fungi and clinical indicators.Results There were no significant differences in baseline characteristics(gender,age,body mass index,etc.)among the 3 groups,but statistical differences were seen in terms of serum indicators(such as serum creatinine,blood urea nitrogen,uric acid,estimated glomerular filtration rate,etc.)(P<0.01).Alpha diversity analysis showed no significant difference was seen between the PKD and HC groups,but the PKD group had significant differences to the NPCKD group(P<0.01).Beta diversity analysis revealed significant differences among the 3 groups and in pairwise comparisons(P=0.001).Fungi composition analysis found that the abundance of Candida was significantly higher in the PKD group than the other 2 groups(P<0.01),while the abundances of Aspergillus and Cladosporium were significantly lower in the PKD group than the HC group(P<0.05).Linear discriminant analysis(LEFSe)indicated that Candida was significantly enriched,while Aspergillus and Cladosporium were significantly reduced in the PKD group.Correlation analysis revealed that the abundance of Cladosporium was negatively correlated with cyst diameter and immunoglobulin light chain Kappa/Lambda ratio in the PKD group(P<0.05),while the abundance of Candida was positively correlated with liver/kidney cyst diameter(P<0.01).Conclusion PKD patients exhibit characteristic changes in gut fungi diversity and composition.The abundances of Cladosporium and Candida are closely associated with clinical indicators of PKD patients.

Objective To explore the factors influencing the occurrence of sarcopenia following esophageal cancer surgery and to as-sess the association between skeletal muscle fat infiltration and postoperative sarcopenia.Methods The retrospective study analyzed clin-ical data from patients who underwent radical esophagectomy in the Department of Thoracic Surgery at the Second Hospital of Lanzhou Uni-versity between January 2020 and December 2022.Based on whether the postoperative loss of skeletal muscle area exceeded 10％,pa-tients were categorized into a sarcopenia group(n=50)and a non-sarcopenia group(n=69).General clinical information,periopera-tive data,and imaging findings were collected.Statistical analyses were performed using R version 3.1.4,and cutoff values were deter-mined by receiver operating characteristic(ROC)curve analysis.Results There were statistically significant differences between the sar-copenia and non-sarcopenia groups in terms of postoperative chemotherapy,lymphocyte count,skeletal muscle area,skeletal muscle in-dex,prognostic nutritional index,and intramuscular fat content(P＜0.05).At the level of the third lumbar vertebra,intramuscular fat content was significantly correlated with the rate of postoperative skeletal muscle loss(r=0.21,P＜0.05),but showed no correlation with the preoperative skeletal muscle area(r=-0.07,P=0.45).Multivariate Logistic regression analysis revealed that preoperative in-tramuscular fat content,skeletal muscle index,and postoperative chemotherapy were independent predictors of postoperative sarcopenia.ROC curve analysis indicated that a cutoff value of-0.647 for preoperative intramuscular fat content at the third lumbar vertebra provided the optimal predictive efficacy for postoperative sarcopenia in esophageal cancer patients[area under the curve(AUC)=0.630,sensitivi-ty=80.00％,specificity=47.80％].Conclusions The degree of skeletal muscle fat infiltration at the L3 level is significantly associat-ed with the development of postoperative sarcopenia in patients with esophageal cancer.Early nutritional support and rehabilitation training in patients with high fat infiltration may help prevent the occurrence of postoperative sarcopenia.

Objective:To develop the Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus to inform the development of targeted interventions for caregivers.Methods:The first draft of the questionnaire was formed through literature analysis, group discussion, semi-structured interviews, Delphi expert consultation and pre-testing based on the theory of knowledge, attitude and practice. Convenience sampling was applied to select homebound elderly diabetic patients within the Shangcheng District of Hangzhou City from August to September 2022, and the questionnaire was subjected to item analysis, reliability test and exploratory factor analysis. Patients within Gongshu District of Hangzhou City were selected from October to November 2022 for questionnaire survey and validation factor analysis.Results:The questionnaire included 31 entries in three dimensions of knowledge, attitude, and practice. The content validity index was 0.96 at the questionnaire level and 0.83 to 1.00 at the entry level. The overall Cronbach's α coefficient for the questionnaire was 0.933, the folded reliability was 0.836, and the retest reliability was 0.913. The exploratory factor analysis cumulative variance contribution was 68.917% and the validation factor analysis showed a good model fit.Conclusions:The Hypoglycemia Prevention Knowledge, Attitude and Practice Questionnaire for Homebound Elderly Patients with Diabetes Mellitus is scientific and practical and can be used to investigate the hypoglycemia prevention knowledge, attitude and practice among homebound elderly diabetic patients.

Objective:To study the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) and primary closure of common bile duct after laparoscopic common bile duct exploration (LCBDE) in treatment of choledocholithiasis complicated with moderate and severe cholangitis.Methods:The clinical data of 127 patients with choledocholithiasis complicated with acute cholangitis admitted to Yantai Affiliated Hospital of Binzhou Medical University from January 2021 to August 2023 were retrospectively analyzed. Finally, 45 patients were enrolled, including 20 males and 25 females, aged (71.3±8.2) years. All 45 patients were treated with sequential PTCD and primary closure of common bile duct after LCBDE. The interval from PTCD to primary closure, white blood cell count, total bilirubin, alanine transaminase before and after PTCD, operation time of primary closure, intraoperative blood loss, postoperative retention time of abdominal drainage tube, postoperative hospitalization time, postoperative complications (bile leakage, bleeding, etc.) were analyzed.Results:The serum total bilirubin, alanine transaminase and white blood cell count of 45 patients were (143.2±32.1) μmol/L, (173.6±23.4) U/L, (16.3±2.9)×10 9/L at admission, and (100.5±21.4) μmol/L, (103.5±12.7) U/L, (8.6±1.7) ×10 9/L after PTCD, respectively. The interval between PTCD and primary closure of common bile duct after LCBDE was (4.3±1.1) d, the operative time of primary closure was (123.4±20.5) min, the amount of intraoperative blood loss was (32.6±8.7) ml. The postoperative hospitalization time was (6.8±1.6) d, and the postoperative retention time of abdominal drainage tube was (4.5±1.3) d, and postoperative complications occurred in 7 cases (15.6%), including biliary leakage in 4 cases (8.9%), subxiphoid incision infection in 1 case (2.2%), and effusion in gallbladder fossa with infection in 2 cases (4.4%). Conclusion:The sequential application of PTCD and primary closure of common bile duct after LCBDE in treatment of choledocholithiasis complicated with moderate and severe cholangitis is a safe, effective and minimally invasive method, and primary closure of common bile duct after LCBDE is safe and reliable within 1 week after PTCD.

AIM: To evaluate the combining ability of prostate-specific membrane antigen (PSMA) targeted radioactive drug

MicroRNAs (miRNAs) are endogenous non-coding small molecular RNAs that widely exist in eukaryotes, and mature miRNAs are composed of 20-25 nucleotide sequences. With the deepening of the research on miRNAs in recent years, it has been found that miRNAs play an important role in the development, progression, prognosis, chemotherapy resistance, and early diagnosis of gallbladder carcinoma. This article reviews the research advances in the role of miRNAs in gallbladder carcinoma.

Objective:To investigate the clinical characteristics, treatments and prognosis of ocular toxoplasmosis (OT).Methods:A retrospective clinical trial. Twelve cases (14 eyes) with OT which was confirmed by clinical and laboratory tests were included in the Department of Ophthalmology, Taihe Hospital in Shiyan and the Department of Ophthalmology, Beijing Chaoyang Hospital in Beijing from July 2011 to June 2019. Among the 12 cases, 6 cases were female (7 eyes) and 6 cases were male (7 eyes). The mean age of the participants was 33.4±12.8 years and the duration of illness ranged from 7 days to 30 years. Fungal endophthalmitis, viral uveitis and non-infectious uveitis were misdiagnosed in 2 cases respectively at the first visit. All the patients underwent BCVA, intraocular pressure, slit-lamp microscope, fundus color photography examinations and toxoplasma-specific serological antibodies tests. Intraocular influid were detected for 7 cases, among which 1 case for antibody only, and 6 cases for Goldmann-witmer coefficient (GWC). Of the 6 cases tested for GWC, 4 cases were tested with PCR assay in the ocular fluid addtionally. FFA was performed in 5 cases (6 eyes) and OCT in 6 cases (6 eyes). Eleven cases were treated with antitoxoplasma therapy. The follow-up duration after treatment varied from 1 week to 39 months. BCVA, clinical features and prognosis were retrospectively analyzed.Results:Specific antibody seropositivity of Toxoplasma gondii was detected in all 12 patients. Of the 7 cases tested with intraocular fluid, 1 case was IgG positive and the other 6 cases with 5 cases with GWC >4 and 1 case with 20.3 in 4 eyes. KPs with or without anterior chamber flash or cells could be detected in 6 eyes,congenital macular defect 1 eye, vitreitis 3 eyes (2 eyes with multiple retinal pigmentation foci and 1 eye with tractive retinal detachment), and coexistence of new and old lesions with Kyrieleis arteritis 2 eyes. Nine eyes showed different degrees of vitreous inflammation (75% of 12 active eyes). Single lesion was present in 4 case (4 eyes) and multiple lesions were present in 8 cases (10 eyes). There were no statistically significant changes in BCVA of OT patients before and after treatment ( P=0.83). Involvement or adjacent to macula of he primary lesions, misdiagnosis and mistreatment led to the poor prognosisi of visual acuity. Conclusions:The fundus of OT can show single lesion or multiple lesions, and the active phase is often accompanied by vitreous inflammation. The primary lesion involves or is close to the macular area, misdiagnosis and mistreatment are the main reasons for the poor visual prognosis of patients.

Objective To evaluate the effects and security of PFNA and DHS in the treatment of unstable intertrochanteric fractures through meta analysis .Methods The randomized controlled trials(RCT) for comparing PFNA and DHS in the treatment of unstable intertrochanteric fracture were retrieved from MEDLINE ,EMbase ,Pubmed ,Cochrane library ,CBM ,CNKI ,VIP data‐bases by computer .The related orthopedic relevant documents and conference papers were collected by manual retrieval .The Rev‐Man5 .1 statistical software was used for conducting the meta analysis .Results Nineteen RCT were included ,involving 1 690 pa‐tients ,in which 871 cases were treated by using PFNA and 819 cases were treated by using DHS .Compared with DHS ,PFNA had the advantages of little trauma ,less blood loss ,short operation time ,short fracture healing time and postoperative bed time ,good hip function and low incidence of postoperative coxa vara and screw cutting ,but there were no statistical differences in the aspects of length of hospital stay ,fatality rate ,and incidences of fracture nonunion ,breakage of internal fixation ,femoral head necrosis ,short‐ening of the femoral neck ,femoral shaft fractures ,deep vein thrombosis ,urinary tract infection and other complications between the two groups(P>0 .05) .Conclusion The retrieved literatures show that PFNA internal fixation is superior to DHS internal fixation in treatment of unstable intertrochanteric fractures .