The rehabilitation compliance of stroke patients is generally low.Evaluating the rehabilitation motivation of patients is helpful to promote the rehabilitation management of patients,enhance the rehabilitation enthusiasm and compliance of patients,and improve the rehabilitation outcome.This paper reviews the existing stroke patients rehabilitation motivation assessment tools,and expounds the main contents,application status,characteristics and limitations of stroke patients rehabilitation motivation assessment tools,in order to provide references for the appropriate selection of clinical assessment tools,the rehabilitation management of stroke patients and the development of domestic localized stroke rehabilitation motivation assessment tools.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

OBJECTIVE: This study aimed to investigate the therapeutic effects of Xiaoyao San (XYS), a herbal medicine formula, on exercise capacity and liver mitochondrial metabolomics in a rat model of depression induced by chronic unpredictable mild stress (CUMS). METHODS: A total of 24 male SD rats were randomly divided into four groups: control group (C), CUMS control group (M), Venlafaxine positive treatment group (V), and XYS treatment group (X). Depressive behaviour and exercise capacity of rats were assessed by body weight, sugar-water preference test, open field test, pole test, and rotarod test. The liver mitochondria metabolomics were analyzed by using liquid chromatography-mass spectrometry (LC-MS) method. TCMSP database and GeneCards database were used to screen XYS for potential targets for depression, and GO and KEGG enrichment analyses were performed. RESULTS: Compared with C group, rats in M group showed significantly lower body weight, sugar water preference rate, number of crossing and rearing in the open field test, climbing down time in the pole test, and retention time on the rotarod test (P < 0.01). The above behaviors and exercise capacity indices were significantly modulated in rats in V and X groups compared with M group (P < 0.05, 0.01). Compared with C group, a total of 18 different metabolites were changed in the liver mitochondria of rats in M group. Nine different metabolites and six metabolic pathways were regulated in the liver mitochondria of rats in X group compared with M group. The results of network pharmacology showed that 88 intersecting targets for depression and XYS were obtained, among which 15 key targets such as IL-1β, IL-6, and TNF were predicted to be the main differential targets for the treatment of depression. Additionally, a total of 1 553 GO signaling pathways and 181 KEGG signaling pathways were identified, and the main biological pathways were AGE-RAGE signaling pathway, HIF-1 signaling pathway, and calcium signaling pathway. CONCLUSION XYS treatment could improve depressive symptoms, enhance exercise capacity, positively regulate the changes of mitochondrial metabolites and improve energy metabolism in the liver of depressed rats. These findings suggest that XYS exerts antidepressant effects through multi-target and multi-pathway.

Objective:To evaluate the level of first morning voided(FMV)urinary luteinizing hor-mone(LH)in girls with breast development,and to determine the value of FMV urine LH in the evalua-tion of central precocious puberty(CPP).Methods:From September 2018 to April 2021,among the patients who were admitted to the Department of Pediatrics of Peking University Third Hospital for"pre-cocious puberty"and underwent gonadotropin-releasing hormone(GnRH)stimulation test,a total of 108 girls were enrolled.According to CPP diagnostic criteria,they were divided into CPP group(n=45)and non-CPP group(n=63).The clinical characteristics and hormone levels of the two groups were com-pared.Receiver operating characteristic(ROC)curve was used to analyze the cut-off value of FMV uri-nary LH in the diagnosis of CPP in girls.Further analyses were done to evaluate the value of FMV urinary LH in the diagnosis of CPP using correlation analysis between urinary LH level and common clinical cha-racteristics.Results:ROC curve analysis showed that FMV urine LH level was significant for the diagno-sis of CPP.The cut-off value of FMV urine LH was 0.69 IU/L(specificity 56.9％,sensitivity 85.0％,area under curve 0.804,P＜0.001).The basic clinical characteristics without GnRH stimulation test were analyzed by binary Logistic regression analysis,indicating that the level of FMV urine LH,uterine volume,ovarian volume and advanced T-bone age had predictive significance for CPP diagnosis in girls(OR values were 2.125,1.961,1.564 and 2.672,respectively).The prediction model was established and the area under the ROC curve was 0.904,P＜0.001.The level of FMV urine LH was positively cor-related with the levels of serum LH,FSH and estrogen before GnRH stimulation test,the peak value of blood LH after GnRH stimulation test,T bone age and uterine volume,with r values of 0.462,0.373,0.242,0.360,0.373 and 0.263,respectively,and P values were＜0.001,＜0.001,0.013,＜0.001,＜0.001 and 0.007,respectively.Conclusion:FMV urine LH can provide a good indication for the diagnosis of CPP.Combining with bone age advanced level and pelvic ultrasound measurement,the pre-dictive value of FMV urine LH can be further improved for the diagnosis of CPP in girls.

Objective:To investigate the effects of Houttuynize Herba decoction on aspirin-induced gastric ulcer (GU) in mice; To discuss its mechanism.Methods:A total of 64 SPF male mice were selected, and 48 mice were randomly selected to establish the model by gavage of 20 mg/ml aspirin solution. The remaining 16 rats were treated as normal group by gavage with the same amount of normalsaline once a day for 7 consecutive days. After successful modeling, the remaining mice in the model group were randomly divided into 5 groups, with 8 mice in each group, namely normal saline group (given normal saline), omeprazole group (given omeprazole 0.5 mg/ml), Houttuynize Herba high-, medium- and low-dosage groups (given 1.08 g/ml, 0.54 g/ml, 0.27 g/ml), and the remaining 8 mice in the normal group were given the same amount of normal saline by gavage. The mice were treated by gavage once a day for 7 days. The number of Escherichia coli and Bifidobacterium in mouse feces was counted by bacterial culture method, and the ratio of Bifidobacterium to Escherichia coli (B/E value) was used to judge the imbalance of bacterial flora. The expression of interleukin-6 (IL-6) in serum was detected by magnetic particle chemiluminescence. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of prostaglandin E 2 (PGE 2) in the serum of mice to determine the level of inflammation. Hematoxylin-eosin staining was used to determine the ulcer and healing. ImageJ 1.8.0 was used to calculate the ulcer inhibition rate. The protein expression levels of IκBα, NF-κB-p65 subunit and phosphorylated IκBα (p-IκBα) and p65 (p-NF-κB-p65) subunits in gastric tissue of mice were evaluated by Western blot. Results:Compared with the normal group, the epithelial cells of the gastric mucosa were missing, the glands were irregularly arranged, and the tissue structure was severely damaged in the modeling group; the number of Escherichia coli in the intestine increased ( P<0.01), the number of Bifidobacterium decreased ( P<0.01), and the B/E value was less than 1 ( P<0.01); Serum PGE2 levels were decreased ( P<0.01), IL-6 levels were increased ( P<0.01); The expression of p-IκBα and p-NF-κB-p65 proteins in gastric tissues was elevated ( P<0.05). After 7 days of drug treatment, compared with the saline group, gastric mucosal cells and structures were improved, and weight gained in the Houttuynize Herba groups ( P<0.05); the rate of inhibition of ulcers in mice in the Houttuynize Herba high-dosage group was significantly improved ( P<0.01); the number of Bifidobacteria in the intestinal tract significantly increased ( P<0.01), that of Escherichia coli was diminished ( P<0.05), B/E value was greater than 1 ( P<0.05), IL-6 content in peripheral blood was reduced ( P<0.05), PGE 2 levels significantly increased ( P<0.01); the level of p-IκBα/IκBα and p-NF-κB-p65/NF-κB-p65 in the gastric tissues of mice decreased ( P<0.01). Conclusion:Houttuynize Herba decoction can effectively improve gastric mucosal injury in mice, and its mechanism may be related to regulating intestinal microorganisms, inhibiting the opening of IκBα/NF-κB pathway, and reducing inflammatory response.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

{L-End}Objective To analyze the correlation between occupational burnout and sleep quality among steelworkers. {L-End}Methods A total of 11 491 steelworkers from a large steel enterprise in Gansu Province were selected as the research subjects using convenient sampling method. The Burnout Questionnaire and the Pittsburgh Sleep Quality Index Scale were used to investigate their occupational burnout and sleep quality. Hierarchical regression analysis was used to analyze the effects of occupational burnout on the sleep quality. {L-End}Results The detection rate of occupational burnout and sleep disorder were 50.4% and 39.0%, respectively. There was a positive correlation between the level of occupational burnout and the total score of sleep quality (Spearman correlation coefficient=0.454, P<0.05). The results of hierarchical regression analysis, adjusting for confounding factors such as gender, age, marital status, education level, alcohol consumption, exercise, weekly working hours, seniority, work shift, noise exposure, dust exposure, and high-temperature work, showed that the score of occupational burnout was positively related to the score of sleep quality(P<0.01), explaining 16.0% of the variance in the score of sleep quality among these steelworkers. {L-End}Conclusion The detection rate of occupational burnout and sleep disorders are relatively high among the steelworkers in this enterprise. Higher levels of occupational burnout are associated with poorer sleep quality. Alleviating occupational burnout among steelworkers may contribute to improving their sleep quality.

Objective:To investigate the effect of cumulative serum uric acid (cumSUA) on early-onset ischemic stroke in young adults.Methods:A prospective cohort study was conducted. A total of 15 607 Kailuan workers who participated in at least two physical check-ups in 2006 and 2008 and at the time of the last physical check-up before 2014 were selected as subjects. Cumulative uric acid exposure during the follow-up period was calculated. The subjects were divided into three groups according to the quantile of cumSUA: the first quantile group was cumSUA<1 563 μmol/L·year, the second quantile group was: 1 563 μmol/L·year≤cumSUA<1 996 μmol/L·year, the third group was cumSUA≥1 996 μmol/L·year. The time of the last physical check-up was regarded as the starting point of follow-up, and early-onset ischemic stroke was regarded as the end event. Kaplan-Meier was used to calculate the incidence of early-onset ischemic stroke in different groups, and Log-rank method was used to calculate the differences in the incidence of early-onset ischemic stroke among different groups. Multivariate Cox regression model was used to analyze the risk of early-onset ischemic stroke in different groups. A four-node (5th, 25th, 75th, 95th percentile) restricted cubic spline plot was used to assess the dose-response relationship between cumSUA and early-onset ischemic stroke.Results:A total of 15 607 subjects were followed up for (7.3±1.1) years. 100 cases with early-onset ischemic stroke were observed with an average age of (46±4) years old. The number of events in the first, second, and third quartile groups was 18, 35, and 47, respectively, and the cumulative incidence rates in the first, second, and third quartile groups were 0.40%, 0.77%, and 1.07%, respectively. The difference in cumulative incidence of endpoint events between the groups was statistically significant by Log-rank test ( χ2=14.96, P=0.003). The results of Cox regression analysis showed that after correcting for confounders, the HR(95% CI) for early-onset ischemic stroke in the second and third quartile groups was [1.67(0.92,3.00), P=0.090; 2.05(1.48,3.69), P=0.020]. Restricted cubic spline results showed a nonlinear correlation between cumSUA and early-onset ischemic stroke after adjysted for confounders. Conclusion:Cumulative serum uric acid is positively correlated with the risk of early-onset ischemic stroke in young adults.

Perinatal loss is one of the most serious childbirth trauma,which seriously affects maternal physical and mental health.At present,the management strategy of maternal lactation can be divided into two aspects:milk return and milk donation.Breast milk donation may build new values of perinatal loss,which can promote maternal physical and mental recovery.This article reviewed the conception,status,motivations,facilitators,barriers and interventions of lactation management in women following perinatal loss,so as to provide bases for improving the awareness of obstetric nursing staff,quality of obstetric care and future research on lactation management in women following perinatal loss in China.