Objective:To analyze the influencing factors of pelvic floor muscle exercise (PFME) compliance in patients with urinary incontinence after laparoscopic radical prostatectomy (LRP) based on the theory of disease uncertainty, and construct a structural equation model, so as to explore the impact mechanisms of disease uncertainty, social support, PFME self-efficacy, and disease coping styles on exercise compliance in patients with urinary incontinence after LRP.Methods:Convenience sampling was used to select 300 postoperative urinary incontinence patients who underwent LRP and PFME at Tenth People's Hospital of Tongji University between June 2023 and June 2024 as study subjects. Patients were assessed using the General Information Questionnaire, PFME Compliance Scale, Mishel Uncertainty in Illness Scale-Adult (MUIS-A), Broome Pelvic Muscle Self-Efficacy Scale (BPMSES), Social Support Rating Scale (SSRS), and Medical Coping Modes Questionnaire (MCMQ). Multiple linear regression analysis was employed to identify factors influencing PFME compliance in patients with urinary incontinence after LRP. Pearson correlation was used to analyze the correlation between PFME compliance and disease uncertainty, self-efficacy, social support, and medical coping styles in patients with urinary incontinence after LRP. AMOS 26.0 software was used for path analysis.Results:A total of 300 questionnaires were distributed, and 282 valid questionnaires were collected, with a valid response rate of 94.00% (282/300). Among 282 patients with urinary incontinence after LRP, the PFME Compliance Scale, MUIS-A, BPMSES, SSRS, and MCMQ scores for confrontation, avoidance, and resignation coping styles were (11.92±2.60), (72.37±14.56), (166.98±17.10), (50.69±6.73), (14.46±2.56), (14.12±2.91), and (12.32±2.58), respectively. PFME compliance showed negative correlations with MUIS-A scores and resignation coping style ( r=-0.559, -0.606; P<0.01), while exhibiting positive correlations with PFME self-efficacy, social support and confrontation coping style ( r=0.494, 0.539, 0.118; P<0.05). Bootstrap mediating analysis showed that disease uncertainty not only directly affected PFME compliance in patients with urinary incontinence after LRP, but also indirectly affected PFME compliance through three pathways: disease uncertainty→ PFME self-efficacy→ PFME compliance, with an effect value of -0.147 [95% CI (-0.250, -0.085) ], accounting for 18.1% of the total effect; disease uncertainty→ resignation coping style→ PFME compliance, with an effect value of -0.184 [95% CI (-0.270, -0.115) ], accounting for 22.7% of the total effect; disease uncertainty→ social support → PFME compliance, with an effect value of -0.173 [95% CI (-0.300, -0.070) ], accounting for 21.4% of the total effect. The indirect total effect constituted 62.2% of the total effect. Conclusions:Patients with urinary incontinence after LRP have low PFME compliance. Disease uncertainty not only directly affects PFME compliance, but also indirectly affects it through PFME self-efficacy, social support, and coping styles.

Objective There is limited research on the combined use of multiple drugs in the prevention and treatment of radiation-induced oral mucositis (RTOM). This study aims to investigate the synergistic effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF), Kangfuxin Liquid, and vitamin B₁₂ via mouthwash on RTOM, and provide a novel approach for the prevention and treatment of acute RTOM. Methods A total of 82 patients with head and neck cancer who underwent radical radiotherapy were randomly divided into four groups: a control group (vitamin B₁₂, 20 cases), observation group 1 (rhG-CSF + vitamin B₁₂, 20 cases), observation group 2 (Kangfuxin Liquid + vitamin B₁₂, 21 cases), and observation group 3 (rhG-CSF + Kangfuxin Liquid + vitamin B₁₂, 21 cases). After 4 weeks of therapy, the therapeutic effects of the four groups were compared. Results Compared to the control group, there was no statistically significant difference in the incidence of RTOM. However, the incidence of severe RTOM was significantly reduced in the observation groups, following the order of observation group 1 (20.00%) > observation group 2 (14.28%) > observation group 3 (9.52%). The initiation period of RTOM in observation group 3 was 24 days, exhibiting a considerable delay in comparison to the control group (16 days), observation group 1 (18 days), and observation group 2 (22 days). The levels of pain experienced by the groups receiving combined treatments were significantly reduced compared to the control group. Observation group 3 exhibited the most effective pain reduction. Conclusion The combined administration of rhG-CSF, Kangfuxin Liquid, and vitamin B₁₂ can prevent radiation-induced oral mucosal injury and promote mucosal healing. This regimen represents an effective strategy for the prevention and treatment of acute RTOM.

Subgingival air polishing can effectively remove plaque and soft deposits attached to the tooth surface and implant surfaces.It is an adjunctive treatment method for periodontitis and peri-implantitis,offering good cleaning efficiency with minimal damage to the root surface and implant surface.Additionally,it promotes the reattachment of fibroblasts to the root surface and osteoblast integration on the implant surface.Subgingival air polishing can improve clinical attachment levels and also shows better therapeutic effects when combined with flap surgery.It provides higher comfort for patients and lower operational difficulty for the dentist.This article aims to an-alyze and summarize in vivo and in vitro studies,reviewing the therapeutic progress of subgingival air polishing in the treatment of peri-odontitis and peri-implantitis.

Objective:To analyze the influencing factors of pelvic floor muscle exercise (PFME) compliance in patients with urinary incontinence after laparoscopic radical prostatectomy (LRP) based on the theory of disease uncertainty, and construct a structural equation model, so as to explore the impact mechanisms of disease uncertainty, social support, PFME self-efficacy, and disease coping styles on exercise compliance in patients with urinary incontinence after LRP.Methods:Convenience sampling was used to select 300 postoperative urinary incontinence patients who underwent LRP and PFME at Tenth People's Hospital of Tongji University between June 2023 and June 2024 as study subjects. Patients were assessed using the General Information Questionnaire, PFME Compliance Scale, Mishel Uncertainty in Illness Scale-Adult (MUIS-A), Broome Pelvic Muscle Self-Efficacy Scale (BPMSES), Social Support Rating Scale (SSRS), and Medical Coping Modes Questionnaire (MCMQ). Multiple linear regression analysis was employed to identify factors influencing PFME compliance in patients with urinary incontinence after LRP. Pearson correlation was used to analyze the correlation between PFME compliance and disease uncertainty, self-efficacy, social support, and medical coping styles in patients with urinary incontinence after LRP. AMOS 26.0 software was used for path analysis.Results:A total of 300 questionnaires were distributed, and 282 valid questionnaires were collected, with a valid response rate of 94.00% (282/300). Among 282 patients with urinary incontinence after LRP, the PFME Compliance Scale, MUIS-A, BPMSES, SSRS, and MCMQ scores for confrontation, avoidance, and resignation coping styles were (11.92±2.60), (72.37±14.56), (166.98±17.10), (50.69±6.73), (14.46±2.56), (14.12±2.91), and (12.32±2.58), respectively. PFME compliance showed negative correlations with MUIS-A scores and resignation coping style ( r=-0.559, -0.606; P<0.01), while exhibiting positive correlations with PFME self-efficacy, social support and confrontation coping style ( r=0.494, 0.539, 0.118; P<0.05). Bootstrap mediating analysis showed that disease uncertainty not only directly affected PFME compliance in patients with urinary incontinence after LRP, but also indirectly affected PFME compliance through three pathways: disease uncertainty→ PFME self-efficacy→ PFME compliance, with an effect value of -0.147 [95% CI (-0.250, -0.085) ], accounting for 18.1% of the total effect; disease uncertainty→ resignation coping style→ PFME compliance, with an effect value of -0.184 [95% CI (-0.270, -0.115) ], accounting for 22.7% of the total effect; disease uncertainty→ social support → PFME compliance, with an effect value of -0.173 [95% CI (-0.300, -0.070) ], accounting for 21.4% of the total effect. The indirect total effect constituted 62.2% of the total effect. Conclusions:Patients with urinary incontinence after LRP have low PFME compliance. Disease uncertainty not only directly affects PFME compliance, but also indirectly affects it through PFME self-efficacy, social support, and coping styles.

Subgingival air polishing can effectively remove plaque and soft deposits attached to the tooth surface and implant surfaces.It is an adjunctive treatment method for periodontitis and peri-implantitis,offering good cleaning efficiency with minimal damage to the root surface and implant surface.Additionally,it promotes the reattachment of fibroblasts to the root surface and osteoblast integration on the implant surface.Subgingival air polishing can improve clinical attachment levels and also shows better therapeutic effects when combined with flap surgery.It provides higher comfort for patients and lower operational difficulty for the dentist.This article aims to an-alyze and summarize in vivo and in vitro studies,reviewing the therapeutic progress of subgingival air polishing in the treatment of peri-odontitis and peri-implantitis.

Objective:To investigate the association of urinary cadmium level with body mass index (BMI) and body circumferences among the older adults over 65 years old in 9 longevity areas of China.Methods:Subjects were older adults over 65 years old from the Healthy Aging and Biomarkers Cohort Study (HABCS) between 2017 and 2018 conducted in 9 longevity areas in China. A total of 1 968 older adults were included in this study. Information including socio-demographic characteristics, lifestyles, diet intake, and health status was collected by using questionnaires and physical examinations. Urine samples were collected to detect urinary cadmium and creatinine levels. Body circumferences included waist circumference, hip circumference and calf circumference. Subjects were divided into three groups (low:<0.77 μg/g·creatinine, middle:0.77-1.69 μg/g·creatinine, high:≥1.69 μg/g·creatinine) by tertiles of creatinine-adjusted urinary cadmium concentration. Multiple linear regression models were used to analyze the association of creatinine-adjusted urinary cadmium level with BMI and body circumferences. The dose-response relationship of creatinine-adjusted urinary cadmium concentration with BMI and body circumferences was analyzed by using restrictive cubic splines fitting multiple linear regression model.Results:The mean age of subjects was (83.34±11.14) years old. The median (Q1, Q3) concentration of creatinine-adjusted urinary cadmium was 1.13 (0.63, 2.09) μg/g·creatinine, and the BMI was (22.70±3.82) kg/m 2. The mean values of waist circumference, hip circumference, and calf circumference were (85.42±10.68) cm, (92.67±8.90) cm, and (31.08±4.76) cm, respectively. After controlling confounding factors, the results of the multiple linear regression model showed that for each increment of 1 μg/g·creatinine in creatinine-adjusted urinary cadmium, the change of BMI, waist circumference, hip circumference, and calf circumference in the high-level group was -0.28 (-0.37, -0.19) kg/m 2, -0.74 (-0.96, -0.52) cm, -0.78 (-0.96, -0.61) cm, and -0.20 (-0.30, -0.11) cm, respectively. The restrictive cubic splines curve showed a negative nonlinear association of creatinine-adjusted urinary cadmium with BMI ( Pnonlinear<0.001) and negative linear associations of creatinine-adjusted urinary cadmium with waist circumference ( Plinear<0.001), hip circumference ( Plinear<0.001), and calf circumference ( Plinear<0.001). Conclusion:Urinary cadmium level is significantly associated with decreased BMI, waist circumference, hip circumference and calf circumference among older adults over 65 years old in 9 longevity areas of China.

Objective To investigate the effective interval of programmed intermittent epidural bolus(PIEB)in labor analgesia with ropivacaine and hydromorphone.Methods A total of 101 puerpera with singleton pregnancy,head position,aged 20-40 years,BMI 20-35 kg/m2,ASA physical status Ⅰ orⅡ,gestational age 37-42 weeks,were randomly allocated into five different PIEB intervals groups:PIEB 40 minutes group(group P40,n=20),PIEB 50 minutes group(group P50,n=19),PIEB 60 minutes group(group P60,n=20),PIEB 70 minutes group(group P70,n=20),and PIEB 80 minutes group(group P80,n=22).The PIEB dose was fixed at 10 ml with the first bolus given 1 hour after the initial manual loading dose with subsequent boluses continued at intervals according to different group allocation.Analgesia was provided using PIEB with 0.1％ropivacaine combined with hydromorphone 15 μg/ml for a total of 12 ml.Based on effective analgesia rate(proportion of women who do not require additional analgesic drugs by the end of the first stage of labor).Probit regression was used to estimate median effective interval(EI50)and 90％effective interval(EI90).VAS pain scores before analgesia,20 minutes,1 hour,2,3,and 4 hours,at full opening of the cervix were recorded.The highest level of sensory blockade and motor blockade(modified Bromage score)were recorded,maternal adverse effects were recorded.Neonatal weight,1 minute and 5 minutes postnatal Apgar scores were recorded.Results Effective analgesia rates were 95.0％,84.2％,70.0％,55.0％,and 50.0％in groups P40,P50,P60,P70,and P80,respec-tively.The EI50 and EI90 were 76.5 minutes(95％CI 69.0-93.9 minutes)and 43.4 minutes(95％CI 17.6-52.7 minutes)analysing by Probit regression.There were no significant differences in VAS pain score at different time,maximum sensory block plane,modified Bromage score,incidence of maternal adverse re-actions and neonatal conditions between the two groups.Conclusion The EI50 and EI90 of PIEB 0.1％ropiv-acaine combined with hydromorphone 15 μg/ml for labor analgesia were 76.5 minutes(95％CI 69.0-93.9 minutes)and 43.4 minutes(95％CI 17.6-52.7 minutes),respectively.

Objective:To investigate the association of urinary cadmium level with body mass index (BMI) and body circumferences among the older adults over 65 years old in 9 longevity areas of China.Methods:Subjects were older adults over 65 years old from the Healthy Aging and Biomarkers Cohort Study (HABCS) between 2017 and 2018 conducted in 9 longevity areas in China. A total of 1 968 older adults were included in this study. Information including socio-demographic characteristics, lifestyles, diet intake, and health status was collected by using questionnaires and physical examinations. Urine samples were collected to detect urinary cadmium and creatinine levels. Body circumferences included waist circumference, hip circumference and calf circumference. Subjects were divided into three groups (low:<0.77 μg/g·creatinine, middle:0.77-1.69 μg/g·creatinine, high:≥1.69 μg/g·creatinine) by tertiles of creatinine-adjusted urinary cadmium concentration. Multiple linear regression models were used to analyze the association of creatinine-adjusted urinary cadmium level with BMI and body circumferences. The dose-response relationship of creatinine-adjusted urinary cadmium concentration with BMI and body circumferences was analyzed by using restrictive cubic splines fitting multiple linear regression model.Results:The mean age of subjects was (83.34±11.14) years old. The median (Q1, Q3) concentration of creatinine-adjusted urinary cadmium was 1.13 (0.63, 2.09) μg/g·creatinine, and the BMI was (22.70±3.82) kg/m 2. The mean values of waist circumference, hip circumference, and calf circumference were (85.42±10.68) cm, (92.67±8.90) cm, and (31.08±4.76) cm, respectively. After controlling confounding factors, the results of the multiple linear regression model showed that for each increment of 1 μg/g·creatinine in creatinine-adjusted urinary cadmium, the change of BMI, waist circumference, hip circumference, and calf circumference in the high-level group was -0.28 (-0.37, -0.19) kg/m 2, -0.74 (-0.96, -0.52) cm, -0.78 (-0.96, -0.61) cm, and -0.20 (-0.30, -0.11) cm, respectively. The restrictive cubic splines curve showed a negative nonlinear association of creatinine-adjusted urinary cadmium with BMI ( Pnonlinear<0.001) and negative linear associations of creatinine-adjusted urinary cadmium with waist circumference ( Plinear<0.001), hip circumference ( Plinear<0.001), and calf circumference ( Plinear<0.001). Conclusion:Urinary cadmium level is significantly associated with decreased BMI, waist circumference, hip circumference and calf circumference among older adults over 65 years old in 9 longevity areas of China.

Objective:To develop a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle, and to verify its effectiveness and repeatability.Methods:A retrospective observational study was conducted. A total of 40 necroses of foot and ankle pedicled flaps were selected by 2 senior surgeons based on the flap surgery performed by the same surgical group in Department of Orthopaedic Surgery, the 920 Hospital of Joint Logistic Support Force of PLA from January 2010 to January 2022. A grading system for pedicled flap necrosis was proposed by a working group and the 40 necrotic flaps were graded. The coincidence rate was calculated to evaluate the effectiveness of the grading system through correlation studies between grading and clinical treatment. One photo of a typical postoperative necrotic flap was collected from each of the 40 flaps. Then 5 extramural surgeons were asked to grade the necroses shown on the photos according to the proposed grading system. Moreover, weighted Kappa analysis was performed on the results of proposed grading system and also on the standard grading currently in use, to evaluate the repeatability of the proposed grading system. Evaluated data were expressed by Mean±SD, and the coincidence rate was expressed by percentage. The reproducibility was studied by weighted Kappa analysis.Results:Of the 40 necrotic flaps, 7 flaps were classified in Grade I, 16 in Grade Ⅱ, 12 in Grade Ⅲ and 5 in Grade IV. In comparison with the actual treatment methods, the overall coincidence rate of the grading system was 92.5%. It indicated that the proposed grading system could effectively guide the selection of a treatment procedure. The average weighted Kappa coefficient of surgeons was at 0.628 with a 95% confidence interval (95%CI) between 0.460-0.796, which was strongly consistent with the standard of the grading system currently in use.Conclusion:The grading system for necrosis of pedicled flap in reconstruction of foot and ankle proposed in this study is simple and clear. It is able to effectively guide the treatment of flap necrosis. The preliminary validation shows that the classification system has good repeatability.

Objective:To evaluate the effects of photodynamic therapy (PDT) in extraction sockets of periodontally compromised molars on soft tissue healing, postoperative pain, bone density and bone height changes.Methods:This study is a single-center, single-blind, randomized controlled superiority clinical trial. Thirty-eight periodontally compromised molars requiring extraction in patients attending the Department of Periodontology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, from December 2022 to September 2023 were included, and randomly assigned to PDT group and control group. The control group received routine debridement after extraction, while PDT group received routine debridement followed by PDT. The bucco-lingual and mesio-distal wound distances at 7 and 14 d after extraction were measured, and then the wound closure rates were calculated. Evaluating the soft tissue healing indexes at 7 and 14 d after extraction. The visual analogue scale was used to assess the pain level at 6 h, 1 d, 2 d, and 3 d after tooth extraction. Apical radiographs were taken immediately and 2 months after extraction in order to compare the changes of the bone density and height.Results:The wound closure rate at 1 week was (78.08±5.45)% in PDT group and (71.03±6.82)% in control group, with significant differences ( P<0.01). The wound closure rate at 2 weeks in PDT group [(85.88±3.84) %] was significantly higher than that in the control group [(81.66±3.79) %] ( P<0.01), but did not reach the superiority value of the superiority test (superiority value=10%, 95% CI at 1 week: 3.00%-11.12%, 95% CI at 2 weeks: 1.71%-6.73%). The soft tissue healing index of PDT group at 1 week was significantly better than the control group ( P<0.05), but there was no significant difference between the two groups at 2 weeks ( P>0.05). There was no significant difference between the two groups in terms of postoperative pain at 6 h, 1 d, 2 d and 3 d as well as in bone density and height changes at 2 months after tooth extraction ( P>0.05). Conclusions:PDT could promote soft tissues healing to some extent, but did not provide additional assistance in the healing of extraction sockets of periodontally compromised teeth. PDT did not show benefits on postoperative pain, changes of the bone density and bone height after tooth extraction.