Objective To assess mid- and long-term outcomes of ascending aortic wrapping (AAW) in adult patients undergoing aortic valve replacement (AVR). Methods We retrospectively analyzed clinical data of adult patients who underwent AVR and AAW in Fuwai Hospital from January 2010 to August 2019. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results A total of 33 patients were enrolled, including 23 males and 10 females aged 22-73 (51.06±12.61) years. There was no perioperative death. The mean preoperative, postoperative and follow-up AAD of the patients were (46.06±3.54) mm, (34.55±5.17) mm, and (37.12±5.64) mm, respectively. The differences in the AAD between pre-operation and post-operation, and between pre-operation and the last follow-up were both statistically significant (P<0.05). The median follow-up time was 38.20 (18.80-140.30) months. The median increase rate of diameter was 0.63 (−0.11, 1.36) mm per year after the surgery. The increase rate was >5 mm per year in 1 patient, and >3 mm in another one. Conclusion The mid- and long-term outcomes of AAW in adult patients undergoing AVR are satisfactory and encouraging.

AIM: To analyze the changes of retinal structure and function before and after panretinal photocoagulation(PRP)in patients with proliferative diabetic retinopathy(PDR).METHODS: Prospective study. Totally 98 cases(98 eyes)of PDR patients who underwent PRP in Eye Hospital of Wenzhou Medical University from January 2022 to May 2023 were included. Optical coherence tomography angiography(OCTA)was used to detect central retinal thickness(CRT), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), foveal avascular zone(FAZ), deep vascular complex(DVC)blood flow density, superficial vascular complex(SVC)blood flow density before and at 1 wk, 1 and 3 mo after PRP. During the follow-up, 1 eye underwent vitrectomy, 2 eyes were lost to follow-up, and finally 95 eyes completed 1 a follow-up, with a loss rate of 3%. According to the visual prognosis at 1 a after treatment, the patients were divided into two groups: 73 eyes in good prognosis group and 22 eyes in poor prognosis group(including 9 eyes of visual disability and 13 eyes of visual regression). The changes in retinal structure and function before and after PRP treatment were compared between the two groups of patients, and the receiver operating characteristic(ROC)curve and decision curve were used to analyze the predictive value of retinal structure and function for PDR treatment.RESULTS: There were statistical significant differences in PDR staging, CRT, CMT, SFCT, DVC blood flow density, and SVC blood flow density between the two groups of patients before treatment(all P<0.05). At 1 wk, 1 and 3 mo after treatment, the FAZ area of both groups decreased compared to before treatment, while the blood flow density of DVC and SVC increased compared to before treatment(both P<0.05). However, there was no significant difference in the blood flow density of FAZ, DVC, and SVC between the two groups at 1 wk, 1 and 3 mo after treatment(all P>0.05). The CRT, CMT and SFCT of the two groups at 1 wk after treatment were higher than those before treatment(all P<0.05), but there were no significant differences between the two groups(all P>0.05). The CRT, CMT and SFCT at 1 and 3 mo after treatment were lower than those at 1 wk after treatment and before treatment in both groups. The CRT, CMT and SFCT in the poor prognosis group at 3 mo after treatment were higher than those at 1 mo after treatment, and were higher than those in the good prognosis group(all P<0.05). ROC analysis showed that, at 3 mo after laser treatment in PDR patients, the area under the curve of the CRT, CMT, and SFCT alone or in combination after treatment for 1 a was 0.788, 0.781, 0.783, and 0.902, respectively, and the combined prediction value was better(P<0.05). Decision curve analysis showed that the combined detection of CRT, CMT, and SFCT in PDR patients at 3 mo after treatment can improve the predictive value of visual prognosis.CONCLUSION: The optimal time for retinal structure and function recovery in PDR patients after PRP treatment is between 1 wk and 1 mo. OCTA measurement of CRT, CMT, and SFCT at 3 mo after treatment can predict the visual prognosis during the 1 a treatment period.

Objective To evaluate the application value of superb microvascular imaging(SMI)in pre-dicting ovarian cancer staging.Methods One hundred and thirty-six patients with ovarian cancer who under-went surgical treatment in our hospital from March 2019 to May 2024 were enrolled.Transvaginal,transab-dominal low-frequency,and transabdominal high-frequency two-dimensional grayscale imaging,Color Doppler Flow Imaging(CDFI),and SMI were performed before surgery for staging prediction.Taking surgical-patho-logical staging as the gold standard,the sensitivity,specificity,and accuracy of the combined application of transvaginal SMI,transabdominal low-frequency SMI,and transabdominal high-frequency SMI for predicting ovarian cancer staging were calculated.The receiver operating characteristic(ROC)curve was established,the area under the ROC curve(AUC)was calculated,and the diagnostic efficacy of SMI for predicting ovarian cancer staging was determined.Results The combined application of transvaginal SMI,transabdominal low-frequency SMI,and transabdominal high-frequency SMI for predicting ovarian cancer staging showed that sen-sitivity was 89.35%,92.36%,81.65%,and 83.21%for stages Ⅰ,Ⅱ,Ⅲ,Ⅳ,respectively;specificity was 86.93%,84.29%,83.39%,and 82.88%;accuracy was 92.50%,94.38%,80.15%,and 84.96%;and AUC was 0.799,0.760,0.695,and 0.727.Conclusion SMI has a high application value in predicting the stage of ovarian cancer,especially for stage Ⅰ and stage Ⅱ ovarian cancer.

Neuroimaging techniques are tools used to investigate and monitor the activity of the nervous system.This study reviews studies that have attempted to quantify athletes'brain using neuroimaging techniques,and summarizes the specific changes in athletes'brain as evidenced by structural magnetic resonance imaging,functional magnetic resonance imaging,functional near-infrared spectroscopy,transcranial magnetic stimulation and electroencephalography.Open-skill sports have been found to increase the brain volume and resting-state functional connectivity related to athletes'executive control,somatosensory processing,vision,and balance coordination,whereas closed-skill sports may decrease the brain volume and resting-state functional connectivity related to athletes'episodic memory,emotional processing and executive functions.Brain regions associated with executive functions,body awareness,motor learning,and episodic memory exhibit stronger activation during tasks.Athletes demonstrate higher neural excitability and neural efficiency.The association between sports training and the brain should be explored through multimodal neuroimaging techniques,which will play a significant role in athlete selection,real-time status monitoring and long-term training supervision.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Objective: To investigate the status quo and associated factors of drinking water knowledge, attitude and behavior among primary school students in rural areas, so as to provide evidence for health behavioral intervention of drinking water in primary school. Methods: Twentythree primary schools in rural area from Hebei, Henan, Shandong and Shanxi provinces were selected by using purposive sampling method from March 1 to April 27 in 2023. Selfdesigned questionnaires regarding knowledge, attitude and behavior of drinking water were distributed to all students in grade 3-6, and 2 173 valid questionnaires were obtained. Multivariate Logistic regression was used to analyze the influencing factors of drinking water knowledge, attitude and behavior of primary school students. Results: The attainment rates of drinking water knowledge, attitude and behavior level were 20.02%, 26.65%, and 31.20%, respectively, among primary school students. The median of daily water intake was 1 000 mL, and the average daily water intake was (1 172.99±771.89)mL. In addition, 66.31% of students water intake reached the minimum standard of 800 mL recommended. The results of multiple Logistic regression indicated that drinking water accessibility in school, health education of drinking water, and individual selfcontrol ability were positively correlated with the knowledge (OR=1.31, 1.57, 1.58), attitude (OR=2.07, 1.65, 1.73), behavior (OR=1.40, 1.49, 1.91) of drinking water and daily water intake (OR=1.41, 1.38, 1.20) (P<0.05). Conclusions Primary school students in rural areas are generally lack of appropriate health awareness on drinking water including knowledge, attitude and behavior. Schools should take targeted measures to focus on the cultivation of students selfcontrol ability, so as to improve students knowledge and attitudes of drinking water, and furthermore help students shape their healthy behaviors of drinking water.

Background and objective Pembrolizumab(PEM)has been shown to be effective in clinical trials for the treatment of advanced non-small cell lung cancer(NSCLC),but clinical trials were based on cohorts of patients selected on specific criteria,and whether the findings are consistent with real-world patients is debatable.The aim of this study is to evaluate the efficacy and safety of PEM in the treatment of advanced NSCLC based on real-world data.Methods A retro-spective collection of real-world data from patients with advanced NSCLC receiving PEM was conducted.Propensity score matching was used to eliminate inter-group differences and assess the efficacy and safety of PEM compared to chemotherapy.Results Among 450 matched patients,the incidence rates of any-grade adverse events were 79.87％in the PEM group and86.71％inthe chemotherapy group,while the incidence rates of grade＞3 adverse events were 4.03％and 7.31％,respectively.The objective response rates were 48.63％for PEM and 36.00％for chemotherapy(P=0.011).The median progression-free survival was 15.5 months for PEM and 8.8 months for chemotherapy(P＜0.001),and the median overall survival was not reached for PEM and 26.2 months for chemotherapy(P＜0.001).Conclusion PEM treatment for advanced NSCLC demonstrates favorable survival outcomes and acceptable safety in real-world clinical practice.

Objective To observe the clinical effect of traditional Chinese medicine bone-setting technique using spinal,pelvi-lower extremity line to treat patients with knee osteoarthritis(KOA).Methods 426 patients with KOA were all from the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine.They were randomly divided into experimental group(384 cases,57 cases of elimination,shedding and termination)by computer generated sequence.Traditional Chinese bone setting techniques were applied with spinal-pelvic-lower limb force line(divided into three parts:lumbar fixed point reduction method,hip joint push-pull and extension method and knee peripheral tendon recovery method every 3 days.2 weeks)treatment;The control group was the waiting treatment group(48 cases,6 cases were eliminated,abscission,termination),which was only used for clinical observation for 2 weeks.The main outcome index was WOMAC pain score.Secondary outcome measures were WOMAC stiffness score,functional score,standardized score and quality of life score(SF-12).The test time points were baseline,2 weeks after enrollment,and follow-up(14 weeks after enrollment).The control group was at baseline and 2 weeks after enrollment.Results Compared with baseline,WOMAC pain score,stiffness score,functional score and standardized score were all decreased in 2 groups 2 weeks after enrollment(P<0.05),but the experimental group was significantly decreased compared with the control group(P<0.001).SF-12 quality of life scores were all higher than before(P<0.001),but the experimental group was significantly higher than the control group(P<0.001).At follow-up,compared with 2 weeks after enrollment,WOMAC pain scores were increased(P<0.001),WOMAC stiffness,joint function and standardized scores were decreased(P<0.001),and SF-12 scores were increased(P<0.001).Conclusion The use of spinal-pelvi-lower extremity line of traditional Chinese medicine bone-setting technique in the treatment of KOA is effective in improving the knee joint function and improving the quality of life of patients,but the short-term effect of pain relief is good,and the long-term effect is not good.Its safety is good,and it can be considered in clinical application for KOA patients with joint dysfunction as the main manifestation.

Objective:To investigate the prognostic relationship between serum KL-6 level and rheumatoid arthritis(RA)combined with interstitial lung disease(RA-ILD).Methods:In Affiliated Hospital of Inner Mongolia Medical University from January 2018 to January 2021,seventy patients with RA were selected and divided into RA-ILD group(34 cases)and RA(36 cases)accord-ing to whether they were complicated with ILD,clinicopathological characteristics of the two groups of patients were analyzed by uni-variate analysis,focusing on the comparison of the expression level of KL-6 in the serum of the two groups and the correlation analysis with laboratory indexes,lung function and imaging,multivariate Logistic regression analysis risk factors affecting RA-ILD.Results:There were significant differences in gender,smoking history,age,age of onset,course of disease,DAS28,KL-6,WBC,UA,RF,anti-CCP antibody,TLC%Pred and DLCO%Pred between the two groups(P<0.05).In RA-ILD group,the proportion of clinical symp-toms was more prominent,joint pain was more prominent,and the thickening of pleural adhesion was more prominent on HRCT;Spearson correlation analysis showed that the level of serum KL-6 in RA-ILD group was significantly negatively correlated with TLC%Pred,VC%Pred and DLCO%Pred(P<0.05);there was a significant positive correlation with RF and anti-CCP antibody levels(P<0.05);there was no significant correlation with FEV1%Pred and FEV1/FVC(P>0.05);expression level of KL-6 in RA-ILD group was significantly higher than that in RA group before treatment,and there was no significant difference after treatment(P>0.05);Fol-lowed up for one year,six patients died in RA-ILD group.The expression level of KL-6 in death group was significantly higher than that in non death group(P<0.05);multivariate Logistic regression analysis showed that old age,male,smoking,increased anti CCP antibody and KL-6 were independent risk factors for RA-ILD(P<0.05);the maximum area under the ROC curve predicted by serum KL-6 was 0.802,the 95%CI was 0.743～0.866,the sensitivity was 0.853,the specificity was 0.827,and the maximum area under the ROC curve detected jointly was 0.854,indicating that the prediction ability of the model was strong.Conclusion:Serum KL-6 levels in RA-ILD patients are significantly increased.KL-6 can be used as a serological index for early detection of ILD,and combined with lung function detection can detect ILD earlier.Early diagnosis is of great significance for treatment and prognosis.

Objective To evaluate the scientificity,transparency and applicability of Chinese guidelines and expert consensuses on nursing published in 2022,in order to improve the quality of guidelines and consensuses.Methods Databases including Medline,Embase,Web of Science,CBM,CNKI,WanFang database,Chinese Medical Journal,and related websites were electronically searched,as well as China Hong Kong,Macao and Taiwan medical journals,to collect Chinese guidelines and expert consensuses on nursing from January to December 2022.STAR tool was used to evaluate the quality of each guidelines and consensuses by 3 assessors independently.Total score,scoring rate of each domain and item were adopted to analyze the outcomes.Results A total of 3 guidelines and 33 expert consensuses were included.The total guidelines and expert consensuses STAR score(33.5±14.3).The quality of guidelines and consensuses was low.The quality of guidelines was moderate with average score of 55.1,and the quality of consensuses was low with average score of 31.5.The included guidelines and consensuses had a highest score rate(52.4％)in the domain of recommendation.Among 39 items of STAR tool,the top 4 items including listing participants and institutions,explaining additional instructions for implementation,describing consensus method,and listing references for recommendations had a high score rate of 100％,83.3％,77.8％,75.0％respectively.However,the items of registration,providing registration information,protocols being searched on public platforms and explaining the role of funding had a low score rate,urgent need for attention and upgrading.Conclusion The overall quality of the Chinese guidelines and expert consensuses on nursing published in 2022 was low.As a medical and nursing practice guidance document,the quality of guidelines and expert consensuses should be improved by encouraging registration,strengthening management of interest conflict,enhancing the rigor of guideline developing process,and expanding the dissemination.