ObjectiveTo establish the self-reported core outcome set （COS） for patients with an example of a community study on heat-sensitive moxibustion for primary hypertension （PH）， to provide a reference for the selection of effectiveness evaluation indicators in community study on heat-sensitive moxibustion. MethodsA systematic literature search was conducted to collect outcomes used in randomized controlled trials and systematic review of heat-sensitive moxibustion for PH （Jan 2021）， and additional outcomes were added through patient and expert questionnaires （Feb 2021） to create a pool of outcome entries. A multidisciplinary expert Delphi survey was conducted to screen outcomes applicable to patient self-reporting （Apr 2021）， and the importance of outcome indicators was rated on a 5-Point Likert Scale. Finally， patient self-reported COS was determined through a consensus conference （June 2021）. ResultsA pool of patient self-reported indicators in the community study of heat-sensitive moxibustion treatment for PH was generated by standardizing and combining the outcome indicators based on the results of the literature search and the questionnaire survey， which consisted of totally 100 measurement tools or contents， excluding 51 indicators or measurement tools required measurement by specialized physicians or hospital equipment， and 49 items were retained to enter the initial list of indicator entries. For the first round of Delphi survey， the mean score for expert familiarity was 0.819， the mean score for basis of judgment was 0.710， and the expert authority coefficient was 0.765， with a total of 21 indicator measurement tools or contents deleted （significance score ≤ 75 or coefficient of variation ＞ 0.25）， 28 retained， and 3 new expert-added indicator entries added. In the second round of Delphi survey， the average score for expert familiarity was 0.859， the average score for basis for judgment was 0.763， and the expert authority coefficient was 0.811， with a total of 11 indicator measurement tools or contents deleted and 20 retained involving 5 domains. Following an expert consensus meeting， 8 outcome indicators were finalized for inclusion in the patient self-reported COS， including 6 indicators of effectiveness evaluation such as quality-of-life scores， blood pressure， traditional Chinese medicine symptom scores， cost-benefit， cardiovascular and cerebrovascular events， and adverse reactions/events， and 2 indicators of factors influencing effectiveness such as sensation of heat-sensitive moxibustion， and adherence. ConclusionIn this study， we initially established a criteria for evaluating the effectiveness in the community study on heat-sensitive moxibustion by constructing patient self-reported COS in the community study on heat-sensitive moxibustion for PH， which can provide a scientific research paradigm for the subsequent development of the community study on heat-sensitive moxibustion.

OBJECTIVE: To investigate the clinical outcome of sensory reconstruction about the functional perforator flap for repairing the complex defects on the limbs. METHODS: A retrospective analysis was conducted on 21 patients with limb complex defects admitted between March 2018 and January 2023. There were 12 males and 9 females, with a median age of 36 years (range, 19-62 years). The wounds were on the upper limbs (hands) in 13 cases and the lower limbs (feet) in 8 cases. Five patients with tumor/scar, and the left defects after en-bloc resection of the tumor lesion and scar were repaired immediately. The remaining 16 cases were acute/chronic wounds, undergoing the emergent debridement and vacuum sealing drainage placement, and the left defects were repaired with flaps during second-stage operation. The size of the defects ranged from 5.5 cm×4.5 cm to 17.0 cm×12.0 cm. The donor sites were located on the thoracic and back in 4 cases, the anterior lateral thigh in 6 cases, and the feet in 11 cases. All flaps were functional perforator flaps with sensory nerve. The donor sites were closed directly or repaired with skin grafting. At last follow-up, the sensation of flap and the muscle strength of recipient site were evaluated according to the British Medical Research Council (BMRC) sensory grading (S₀-S₄) and muscle strength grading (M₀-M₅) criteria. RESULTS: Twenty flaps survived completely without significant complication, and partial edge necrosis was observed in 1 flap, which healed after the debridement and skin grafting. The donor and recipient sites healed by first intention. All patients were followed up 10-18 months (mean, 12 months). At last follow-up, the flaps with satisfactory shape and soft texture were observed, and no abnormal hair growth or pigmentation occurred. The sensation of flap was evaluated as S₁ in 2 cases, S₂ in 7, S₃ in 9, and S₄ in 3. The muscle strength of recipient site was evaluated as M₂ in 4 cases, M₃ in 9, M₄ in 5, and M₅ in 3. Only linear scars were left at the donor site. CONCLUSION The functional perforator flap with sensory nerve is beneficial for early sensation reconstruction for repairing the complex defects on the limbs, and could reconstruct the functional subunit structure defect in one stage. The short-term functional follow-up results are satisfactory.
Humans ; Male ; Adult ; Female ; Perforator Flap/transplantation* ; Middle Aged ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Young Adult ; Treatment Outcome ; Extremities/injuries* ; Cicatrix/surgery* ; Skin Transplantation/methods*

Chemotherapy is currently the mainstay of systemic management for triple-negative breast cancer (TNBC), but chemoresistance significantly impacts patient outcomes. Our research indicates that Doxorubicin (Dox)-resistant TNBC cells exhibit increased glycolysis and ATP generation compared to their parental cells, with this metabolic shift contributing to chemoresistance. We discovered that ALKBH3, an m¹A demethylase enzyme, is crucial in regulating the enhanced glycolysis in Dox-resistant TNBC cells. Knocking down ALKBH3 reduced ATP generation, glucose consumption, and lactate production, implicating its involvement in mediating glycolysis. Further investigation revealed that aldolase A (ALDOA), a key enzyme in glycolysis, is a downstream target of ALKBH3. ALKBH3 regulates ALDOA mRNA stability through m¹A demethylation at the 3'-untranslated region (3'UTR). This methylation negatively affects ALDOA mRNA stability by recruiting the YTHDF2/PAN2-PAN3 complex, leading to mRNA degradation. The ALKBH3/ALDOA axis promotes Dox resistance both in vitro and in vivo. Clinical analysis demonstrated that ALKBH3 and ALDOA are upregulated in breast cancer tissues, and higher expression of these proteins is associated with reduced overall survival in TNBC patients. Our study highlights the role of the ALKBH3/ALDOA axis in contributing to Dox resistance in TNBC cells through regulation of ALDOA mRNA stability and glycolysis.

【Objective】 To develop the Visual Cognitive Ability Assessment Scale for Preschool Children and to evaluate its reliability and validity, in order to provide reference for clinical evaluation of visual cognitive ability of preschool children. 【Methods】 1) From November 2021 to February 2022, construct the dimension framework was constructed and the pool of scale items was compiled according to the theory. 2) In March to June 2022, items were screened preliminarily through group discussion and Delphi method. In August 2022, the entries was revised by a pre-survey in a small sample (n=50). 3) Parents of children aged 4 - 7 from 8 kindergartens in 4 main urban areas of Nanjing were investigated by stratified cluster random sampling method in September to December 2022. The valid sample of the first survey (n=344) was analyzed to conduct item analysis and re-test reliability analysis, the valid sample of the second survey (n=695) was tested for reliability and confirmatory factor analysis, then the scale was finally compiled and evaluated. 【Results】 1) The scale contained 19 items in 4 dimensions:visual memory, discerning vision, spatial vision and visual integration. All items passed the project analysis test. 2) The Cronbach′s α coefficient of each dimension ranged from 0.604 to 0.886, and the Cronbach′s α coefficient of the whole scale was 0.917. During the two surveys, the scores of each item were correlated, and the average retest reliability coefficient was 0.601 (P< 0.05). 3) Content validity index (S-CVI) at scale level was 0.91, and item level content validity index (I-CVI) ranged from 0.8 to 1.0. After several rounds of model modification, the confirmatory factor model fit well. 【Conclusion】 The reliability and validity of the Visual Cognitive Ability Assessment Scale for Preschool Children are acceptable and meet the requirements of the scale, which provides a practical tool for clinical screening of visual and cognitive disorders.

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Objective:To systemically evaluate the characteristics of cytokine levels in intraocular fluid of neovascular glaucoma (NVG).Methods:Literature on the detection of cytokine levels in NVG published before June 2022 was searched in PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang databases, and China Science and Technology Journal Database (VIP).Two investigators independently completed the literature search, inclusion, and data extraction following the inclusion and exclusion criteria.Quantitative analyses were performed using Stata 16.0 software.Study heterogeneity was assessed using the I2 test, and effects were combined using the appropriate effect model to complete the meta-analysis. Results:A total of 24 studies were screened, including 771 NVG cases and 727 age-related cataract cases (control group).The standardized mean difference ( SMD) of the combined effect value of vascular endothelial growth factor (VEGF) mass concentration in the aqueous humor between the two groups was 8.79, with a 95% confidence interval ( CI) of 6.43 to 11.14.The SMD of interleukin-6 (IL-6) between the two groups was 12.50, with a 95% CI of 9.41 to 15.58.The VEGF and IL-6 levels in aqueous humor and vitreous humor were significantly higher in NVG group than in control group (all at P<0.05).The pigment epithelium-derived factor (PEDF) level in aqueous humor was lower in NVG group than in control group ( SMD: -3.03, 95% CI: -5.50--0.55, P<0.05).The levels of IL-8 ( SMD: 3.99, 95% CI: 1.14-6.85), erythropoietin (EPO) ( SMD: 9.62, 95% CI: 0.44-18.79), placental growth factor (PIGF) ( SMD: 2.62, 95% CI: 1.38-3.86), tumor necrosis factor-α (TNF-α) ( SMD: 3.37, 95% CI: 1.87-4.87) were all significantly higher in NVG group than in control group (all at P<0.05).There was no significant difference in IL-1β level in aqueous humor between the two groups ( P>0.05). Conclusions:In NVG patients, VEGF, IL-6, IL-8, EPO, PIGF, TNF-α levels are obviously increased and PEDF level is obviously decreased.These biomarkers can be used as potential predictors or therapeutic targets for NVG.

Objective To explore the specific plasma exosomal protein expression in Coronary Heart Disease(CHD)with phlegm-turbidity syndrome(PTS),so as to provide biological reference for the diagnosis of CHD with PTS.Methods A total of 20 CHD patients with PTS and 20 healthy subjects at the same period were included.Plasma exosomes were extracted from all subjects using the qEV size exclusion method.First,10 CHD cases with PTS and 10 healthy subjects were randomly selected,and differentially expressed proteins between the two groups were screened using label free non-targeted protein quantification analysis.Then,MRM targeting protein labeling technique was applied to verify the differentially expressed proteins in the remaining subjects.Results Compared with healthy controls,214 differentially expressed plasma exosomal proteins(61 up-regulated and 153 down-regulated)were found in CHD patients with PTS,mainly related to cholesterol metabolism,complement and coagulation cascade,and immune effects.ANXA6,C4BPB,F8,CFB,APOE,C9,and CLU proteins were further validated by MRM targeting protein.Conclusion CHD patients with PTS had differences in plasma exosomal protein expression from healthy controls,and the differential proteins are mainly related to cholesterol metabolism,complement,and the coagulation cascade.

Objective:To compare the effect of percutaneous screw-rod system combined with sacroiliac screw internal fixation and non-operation of type II-IV fragility fracture of the pelvis (FFP).Methods:A retrospective multicentral cohort study was performed to analyze the clinical data of 74 patients with FFP treated in Jiangjin Central Hospital of Chongqing and Hechuan People′s Hospital of Chongqing from January 2017 to June 2021, including 23 males and 51 females, aged 62-95 years [(79.3±7.3)years]. A total of 41 patients received non-surgical treatment (non-operation group). and 33 patients received percutaneous screw-rod system combined with sacroiliac screw internal fixation (operation group). The time to get out of bed, visual analog scale (VAS) and Majeed score on admission and at 1, 3, 6, 12 months after treatment, fracture healing time and complications were evaluated in the two groups.Results:Except for 9 patients who died at 3-9 months after treatment, the remaining patients were followed up for 12-24 months [(13.5±3.2)months]. The time to get out of bed was (11.4±2.8)days in operation group and was (67.4±4.4)days in non-operation group ( P<0.01). The VAS and Majeed score at 1, 3, 6 and 12 months after treatment were significantly improved in both groups compared with those on admission (all P<0.05). There was no significant difference in VAS and Majeed score between the two groups on admission (all P>0.05). The VAS was (3.2±0.7)points in operation group compared to (4.2±0.8)points in non-operation group at 1 month after treatment, and was (1.8±0.5)points in operation group compared to (2.9±0.7)points in non-operation group at 3 months after treatment (all P<0.01). The Majeed score was (56.0±2.4)points in operation group compared to (40.4±2.7)points in non-operation group at 1 month after treatment; the score was (77.3±2.6)points in operation group compared to (57.7±4.2)points in non-operation group at 3 months after treatment; the score was (86.5±1.8)points in operation group compared to (79.6±2.8)points in non-operation group at 6 months after treatment (all P<0.01). In contrast, the two groups had no statistically significant difference in VAS at 6 months and 12 months after treatment and Majeed score at 12 months after treatment (all P>0.05). There was no statistically significant difference in the fracture healing time between the two groups ( P>0.05). There was no statistically significant difference in the incidence of complications related to fixation methods between the two groups ( P>0.05). The incidence of bed-related complications was 24.2% (8/33) in operation group and was 51.2% (21/41) in non-operation group ( P<0.05). The 1-year fatality rate was 3.0% (1/33) in operation group and 19.5% (8/41) in non-operation group ( P<0.05). Conclusion:Compared with non-operative treatment, percutaneous screw-rod system combined with sacroiliac screw internal fixation in the treatment of type II-IV FFP can allow early off-bed movement, effectively relieve pain, improve quality of life of the patients, and reduce complication rate.

Objective To understand the epidemiological and etiological characteristics of hand-foot-mouth disease (HFMD) in Shijiazhuang City from 2009 to 2021, and to provide scientific evidence for the prevention and control of HFMD. Methods The epidemic data and etiological data of HFMD in Shijiazhuang City from 2009 to 2021 were collected, and descriptive epidemiological methods were used for data analysis. Results The reported incidence of HFMD in Shijiazhuang showed a fluctuating downward trend from 2009 to 2021, with a high incidence every other year in most years. The proportion of severe cases and the mortality rate showed a decreasing trend (χ²_{severe cases}=282.09, P<0.001; χ²_mortality=51.33, P<0.001). There were two peaks of HFMD incidence throughout the year: the main peak occurring in spring and summer and the secondary peak occurring in autumn and winter. The peak month of incidence showed a backward trend after 2015. Cases were mainly children aged 5 years and below. The ratio of male to female was 1.53:1, and the gender incidence rate was significantly different (χ²=4 507.84，P<0.001). The deaths were mainly children aged 2 years old and below, accounting for 88.89%. The incidence of HFMD decreased with age (t_r=-2.85，P<0.05). The highest incidence was in urban areas (114.50/100 000). The pathogenic composition of different cases was different and the difference was statistically significant (χ²2 =521.86，P<0.001). The dominant pathogens in mild cases presented diverse characteristics. EV71 was dominant in severe cases and death cases, accounting for 82.77% and 96.67%, respectively. The proportion of other enteroviruses in severe cases showed an increasing trend. A total of 630 745 doses of EV71 inactivated vaccine were administered in Shijiazhuang from 2017 to 2021, with an average annual vaccination rate of 8.53%. After the implementation of EV71 vaccination, the proportion of severe cases, the mortality rate and the proportion of EV71 all decreased compared to those before, and the differences were statistically significant (χ²_{proportion of severe cases}=93.71，P=0.000，χ²_{mortality rate}=26.62，P=0.000，χ²_{proportion of EV71}=1060.86，P=0.000). Conclusion The incidence of HFMD in Shijiazhuang presented a declining trend, and the dominant etiological changes of different cases were different. It is necessary to continue to strengthen the etiological monitoring, health education and EV71 vaccination for the prevention and control of HFMD.

In recent years,mechanical thrombectomy has been the most important research progress in the treatment of acute cerebral infarction,especially the positive results of five endovascular therapy studies in 2015 has rewritten its clinical guidelines.However,the focus of these studies was mainly on the small vessel infarction(SVI),and the inclusion criteria of these studies include the following aspects:ASPECTS ≥6 points,Alberta Stroke Program Early CT Score within 6 hours after stroke onset,the infarct volume＜70 mL within 6-24 hours after stroke onset,and the presence of image mismatch or the presence of mismatch between clinical condition and perfusion imaging.The above studies excluded patients with ASPECTS＜6 points or infarct volume ≥70 mL of large core infarction(LCI).With the continuous progress of the endovascular treatment of acute ischemic stroke(AIS),the mechanical thrombectomy therapy strategy has crossed from the"time window"to the"tissue window",meanwhile,the therapeutic goal of mechanical thrombectomy has also moved from treating SVI to a new era of treating LCI that has been a very hot topic recently.Whether endovascular treatment is beneficial for patients with LCI remains uncertain.This paper aims to make a comprehensive review concerning the relevant research progress in endovascular therapy for anterior circulation large core ischemic stroke,including the imaging determination and study inclusion criteria of LCI,the postoperative blood pressure management,and the factors influencing ineffective recanalization and prognosis.(J Intervent Radiol,2023,32:1256-1262)