Objective:To analyze the clinical characteristics，laboratory tests，endoscopic features，treatment，and follow-up of peptic ulcers caused by eosinophilic gastrointestinal disorders（EGIDs）in children，with the aim of improving the level of understanding，diagnosis and treatment of EGIDs in children with the onset of peptic ulcers.Methods:A retrospective analysis was conducted on children admitted to the Department of Gastroenterology，Capital Center for Children's Health，Capital Medical University from January 1st，2019 to October 31st，2023，who underwent complete endoscopic examination. The first examination showed the presence of peptic ulcers（gastric or duodenal ulcers）under the endoscope，and were ultimately diagnosed with peptic ulcers caused by EGIDs through examination and follow-up. The clinical characteristics，laboratory tests，endoscopic results，and treatment follow-up were analyzed.Results:Thirty-five children were EGIDs，22 males and 13 females.Twenty-two cases（62.9%）had abdominal pain as the main symptom.Laboratory tests：17 cases（48.6%）showed a decrease in hemoglobin，15 cases（42.9%）showed an increase in eosinophil count，20 cases（57.1%）tested gastro positive for food allergen specific IgE，and 17 cases（48.6%）showed thickening of the intestinal wall on gastrointestinal ultrasound. Endoscopic features：8 cases（22.9%）showed gastric antral ulcers，including 7 cases（20.0%）with multiple gastric antral ulcers，and 25 cases（71.4%）showed duodenal bulb ulcers.There were 15 cases（42.9%）showed huge ulcers，and 14 cases（40.0%）were located in the duodenal bulb. Comparison of clinical characteristics between children with EGIDs（EGIDs group）and those with peptic ulcers caused by Helicobacter pylori infection（Hp group）：the first clinical symptom in both groups was mainly abdominal pain，but the incidence rate in the EGIDs group was lower（62.9% vs 93.5%），and the weigth for length Z score in the EGIDs group was lower［0（-1.6，0.8）vs 1.1（0，1.9）］，with statistical significance（all P<0.05）. Comparison of laboratory tests：the EGIDs group showed a statistically significant difference in hemoglobin levels［120（101，124）g/L vs 130（100，138）g/L］，eosinophil count［0.28（0.13，0.71）× 10 9/L vs 0.16（0.08，0.22）×10 9/L］，a positive rate of food allergen specific IgE detection（57.1% vs 32.3%），and a positive rate of intestinal wall thickening detected by gastrointestinal ultrasound（48.6% vs 16.1%）compared with the Hp group（all P<0.05）. Comparison of endoscopic examinations：multiple ulcers in the gastric antrum were more common in the EGIDs group than in the Hp group（20.0% vs 0），and the difference was statistically significant（ P<0.05）. Conclusion:For children with peptic ulcers with onset of abdominal pain，with anemia or malnutrition，or multiple ulcers in the gastric antrum and huge ulcers in the duodenal bulb detected by endoscopy，it is recommended to perform multi site biopsies to help diagnose EGIDs early.

Objective:To explore the mechanism of Hegu(LI4)point's effect on facial nerve from the perspective of modern medicine.Additionally,it seeks to investigate the specificity of LI4 effect on the face in comparison with other points,providing guidance for the clinical practice of acupuncture.Method:Twenty healthy subjects were enrolled in a crossover design(homozygous self before and after con-trol).The volunteers were randomly assigned to the LI4 group and the Quchi(LI11)group,with a two-week interval between the two groups was used as the washout period.The motor evoked potentials(MEPs)of the facial buccal muscles were compared before and after acupuncture in the LI4 and LI11 groups under various in-tensities of transcranial magnetic stimulation(TMS).The latency and amplitude of MEPs were measured at each intensity of TMS.At the end of the first trial,all volunteers entered the second trial after a two-week in-terval,with the grouping method of the second trial being the same as that of the first trial.The amplitude and latency of buccal muscle MEPs were recorded at eight time points(before needling,needling,leaving the needle in place for 3 minutes,electro-acupuncture,3 minutes after electro-acupuncture,switching off electro-acu-puncture,3 minutes after switching off electro-acupuncture and pulling out the needle)at a stimulation intensity.Result:The amplitude of buccal muscle MEPs increased significantly and the latency decreased significantly before and after the intervention in the LI4 and LI11 groups under TMS intensity of 1％to 25％.The differ-ence was statistically significant(P<0.001),and the rate of change in the amplitude of buccal muscle MEPs in the LI4 and the rate of change in the amplitude of buccal muscle MEPs in the LI4 group was significantly higher than that in the LI11 group(P<0.01).In test 2,the amplitude of buccal muscle MEPs in the LI4 group was lower than that in the LI11 group before acupuncture(P<0.01).The amplitude of buccal muscle MEPs was higher than that in the LI11group after electro-acupuncture,electro-acupuncture for 3 minutes,switching off electro-acupuncture,and switching off electro-acupuncture for 3 minutes(P<0.05).The latency of buccal muscle MEPs was lower than that of the LI4 group in the LI11group before,after,electro-acupunc-ture,electro-acupuncture,electro-acupuncture for 3 minutes,and switching off electro-acupuncture(P<0.05).There was no statistically significant difference between the two groups in other intervention phases(P>0.05).Conclusion:In the physiological state,needling both Hegu and Quchi increased buccal muscle excitability,and Hegu acupoints were more specific for increasing buccal muscle excitability compared with Quchi acu-points.

Objective:To explore the mechanism of Hegu(LI4)point's effect on facial nerve from the perspective of modern medicine.Additionally,it seeks to investigate the specificity of LI4 effect on the face in comparison with other points,providing guidance for the clinical practice of acupuncture.Method:Twenty healthy subjects were enrolled in a crossover design(homozygous self before and after con-trol).The volunteers were randomly assigned to the LI4 group and the Quchi(LI11)group,with a two-week interval between the two groups was used as the washout period.The motor evoked potentials(MEPs)of the facial buccal muscles were compared before and after acupuncture in the LI4 and LI11 groups under various in-tensities of transcranial magnetic stimulation(TMS).The latency and amplitude of MEPs were measured at each intensity of TMS.At the end of the first trial,all volunteers entered the second trial after a two-week in-terval,with the grouping method of the second trial being the same as that of the first trial.The amplitude and latency of buccal muscle MEPs were recorded at eight time points(before needling,needling,leaving the needle in place for 3 minutes,electro-acupuncture,3 minutes after electro-acupuncture,switching off electro-acu-puncture,3 minutes after switching off electro-acupuncture and pulling out the needle)at a stimulation intensity.Result:The amplitude of buccal muscle MEPs increased significantly and the latency decreased significantly before and after the intervention in the LI4 and LI11 groups under TMS intensity of 1％to 25％.The differ-ence was statistically significant(P<0.001),and the rate of change in the amplitude of buccal muscle MEPs in the LI4 and the rate of change in the amplitude of buccal muscle MEPs in the LI4 group was significantly higher than that in the LI11 group(P<0.01).In test 2,the amplitude of buccal muscle MEPs in the LI4 group was lower than that in the LI11 group before acupuncture(P<0.01).The amplitude of buccal muscle MEPs was higher than that in the LI11group after electro-acupuncture,electro-acupuncture for 3 minutes,switching off electro-acupuncture,and switching off electro-acupuncture for 3 minutes(P<0.05).The latency of buccal muscle MEPs was lower than that of the LI4 group in the LI11group before,after,electro-acupunc-ture,electro-acupuncture,electro-acupuncture for 3 minutes,and switching off electro-acupuncture(P<0.05).There was no statistically significant difference between the two groups in other intervention phases(P>0.05).Conclusion:In the physiological state,needling both Hegu and Quchi increased buccal muscle excitability,and Hegu acupoints were more specific for increasing buccal muscle excitability compared with Quchi acu-points.

ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.

Objective:To establish a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography (MDCTA) and to explore its clinical application effects.Methods:This study was a retrospective observational study. From January 2021 to October 2023, 7 patients and 6 patients with post-traumatic skin and soft tissue defects in extremity and conformed to the inclusion criteria were admitted to the Affiliated Hospital of Jiangsu University and Wuxi No. 9 People's Hospital, respectively. There were 8 males and 5 females, aged 21 to 68 years. Nine patients had wounds on the hand and 4 patients had wounds on the foot. The wound area after debridement ranged from 8.0 cm×6.0 cm to 18.0 cm×17.0 cm. Through the three-dimensional navigation process based on MDCTA, 14 perforator flaps were designed and resected, including 11 free anterolateral thigh perforator flaps and 3 pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain, with flap size ranging from 9.0 cm×6.0 cm to 20.0 cm×15.0 cm. Six wounds in the flap donor sites were directly sutured, and eight wounds in the flap donor sites were transplanted with skin grafts. The consistency of the location, type, and source of the perforators was compared between the preoperative navigation display and actual intraoperative detection. Immediately after surgery, the coverage of wound by the flap was evaluated according to the self-made criteria. The postoperative flap survival was observed. The occurrence of complications was observed during follow-up. At the last follow-up, the appearance of the flaps was observed, the blood supply of the flaps and the hand function of the 9 patients with hand trauma were evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the foot function of the 4 patients with foot trauma was assessed using the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scoring System.Results:The location, type, and source of the perforators displayed in preoperative navigation were consistent with the actual intraoperative detection. Immediately after surgery, the coverage of the wounds by 11 flaps was rated as excellent, and that of 3 flaps was rated as moderate. Postoperatively, 13 flaps survived completely, and 1 flap had partial necrosis, which healed after a full-thickness skin grafting from the thigh. Patients were followed up for 4 to 24 months postoperatively, one patient developed a hematoma under the flap, and one patient had local infection. At the last follow-up, the flaps of all patients were good in color and texture, and 5 patients with bloated flaps post operation had good appearance after thinning surgery; the blood supply was excellent in 12 flaps and was good in 2 flaps; among patients with hand trauma, the hand function was rated as excellent in 2 cases, good in 4 cases, and poor in 3 cases; among patients with foot trauma, the foot function was rated as excellent in 3 cases and good in 1 case.Conclusions:The three-dimensional navigation process for design and resection of perforator flaps based on MDCTA realizes precise evaluation of perforator vessels in flap donor sites and skin and soft tissue defects in the recipient sites. Guided by the three-dimensional navigation process, the application of free anterolateral thigh perforator flaps and pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain in repairing skin and soft tissue defects in extremity realizes precise surgery, reducing flap donor site injury and achieving excellent clinical outcomes.

Objective:To analyze the practical experiences and challenges faced by nurses in community-based elderly care institutions in the management of insulin therapy for elderly patients with diabetes.Methods:This qualitative study employed purpose sampling to recruit nurses from two community-based elderly care institutions in Beijing from June to October 2023. Semi-structured interviews were conducted focusing on their experiences and challenges in insulin use for elderly patients with type 2 diabetes. All interviews were audio-recorded and transcribed into text. Framework analysis was used to analyze the interview data.Results:A total of 15 nurses participated in the interviews, all of whom were female with work experience ranging from 4 to 12 years. The analysis revealed three main themes and 2-3 subthemes under each theme. Theme 1 patients′ experiences with insulin injection: concerns about adverse reactions such as hypoglycemia, obesity, and injection pain; attention to insulin dosage, blood glucose levels, dietary management, and weight control. Theme 2 nurses′ practices and challenges in insulin management: communication and emotional support; trust-building between nurses and elderly patients; impact of insufficient human resources. Theme 3 nurses′ experiences with diabetes knowledge education and training: motivation for training; adaptation of training content, format and frequency to local conditions; implementation and significance of health education.Conclusions:The management of elderly people with diabetes in community-based elderly care institutions presents significant challenges. It is essential to provide personalized insulin management support, emotional support, and psychological counseling for elderly diabetic patients. Additionally, nurses require access to relevant diabetes knowledge education and training to enhance their ability of effective care.

Objective:To assess medication adherence and identify independent associated factors among elderly patients with multimorbidity attending the Department of General Practice at Zhoukou Central Hospital.Methods:This cross-sectional study enrolled 380 elderly patients with multimorbidity through convenience and snowball sampling between March 2023 and March 2024. Face-to-face interviews were conducted with the subjects through community general practice clinics and resident group discussions. The survey covered the subjects′ general clinical information and medication adherence. Medication adherence was assessed using the Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analyzed independent factors of medication adherence in elderly patients with multimorbidity.Results:A total of 380 patients were included in the analysis, with an mean age of (71.57±7.58) years, and 211 (55.5%) were males. Only 50 patients (13.2%) demonstrated good adherence. Multivariate logistic regression revealed lower adherence in ages 60-69 vs.≥80 ( OR=4.595, 95% CI:1.730-12.207, P=0.002), higher adherence in high school and above education vs. primary/illiterate ( OR=0.278, 95% CI:0.082-0.944, P=0.040), reduced adherence with increased household responsibility ( OR=3.684, 95% CI:1.799-7.543, P<0.001). Conclusions:Medication adherence was suboptimal among elderly patients with multimorbidity attending the Department of General Practice at Zhoukou Central Hospital. Age, education, and household responsibility burden were independent predictors for medication adherence.

Objective:To explore the correlation between abnormal vital signs (e.g., heart rate, oxygen saturation, and body temperature) and acute exacerbations in patients with chronic obstructive pulmonary disease (COPD), as well as to evaluate the clinical value of continuous monitoring via wearable devices for the early warning and intervention.Methods:A multicenter cross-sectional study enrolled 335 patients with stable chronic obstructive pulmonary disease (COPD) from 12 community health centers in Beijing and Chengdu between June 2023 and May 2024. General demographic and clinical data were collected, and each participant underwent continuous monitoring of resting heart rate, oxygen saturation, and body temperature using wearable devices for 21 days. Based on whether participants had experienced acute exacerbations requiring outpatient, emergency, or inpatient treatment within the previous year, they were categorized into the acute exacerbation group and the non-exacerbation group. Differences in physiological parameters between the acute exacerbation group and non-exacerbation group were analyzed, and contributing factors were assessed using logistic regression analysis.Results:A total of 335 patients with stable COPD were enrolled, including 252 cases (75.22%) in the acute exacerbation group and 83 cases (24.78%) in the non-acute exacerbation group. There were no statistically significant differences in age, sex distribution, comorbidities, or baseline lung function between the two groups (all P>0.05). Compared with the non-acute exacerbation group, patients in the acute exacerbation group had a faster resting heart rate((76.01 ± 7.78) beats/min vs. (72.72 ± 7.35) beats/min, t=3.126, P=0.002), a higher proportion of patients with decreased oxygen saturation (1.75% (0.97%, 3.03%) vs. 0.86% (0.44%, 1.65%), Z=11.086, P=0.001), and a higher proportion of patients with elevated body temperature (0.60% (0.39%, 1.03%) vs. 0.31% (0.17%, 0.54%), Z=7.314, P=0.007). Logistic regression analysis showed that advanced age ( OR=1.051, 95% CI: 1.023-1.080), increased heart rate ( OR=1.055, 95% CI:1.013-1.098), decreased oxygen saturation ( OR=1.197, 95% CI:1.023-1.400), and elevated body temperature ( OR=1.777, 95% CI:1.148-2.752) were positively associated factors for acute exacerbation of COPD. Conclusions:Abnormalities in physiological indicators such as heart rate, oxygen saturation, and body temperature are associated with acute exacerbations in COPD patients. Continuous monitoring using wearable devices may provide a new method for early warning and timely intervention in COPD exacerbations.

Objective To analyze the basic conditions and pathological characteristics of the samples in the Human Brain Bank of Hebei Medical University,which were pathologically diagnosed as cerebral amyloid angiopathy,and to provide reference for the research of related diseases.Methods The basic data of gender,age,apolipoprotein E genotype,pathological classification of cerebral amyloid angiopathy,Alzheimer's disease-related pathological change score,comorbidities and other pathological information were analyzed.Results Up to October 2024,twenty samples were confirmed by pathological diagnosis,with a male to female ratio of 3:1 and an average age of(80.90±8.08)years.Involve three kinds of apolipoprotein E subtype,5 kinds of genotypes(ε2/ε3 xε2/ε4、ε3/ε3 xε3/ε4、ε4/ε4);There were 2 pathologic types,including 6 cases of type 1 and 14 cases of type 2.The pathological grade included 3 grades.The severity grade and subtype classification of cerebral amyloid vascular disease were correlated with the degree of pathological changes of Alzheimer's disease.Cerebral amyloid angiopathy samples could coexist with other degenerative diseases with high comorbidity.Conclusion The incidence of cerebral amyloid angiopathy is higher in the aged samples collected based on Brain Bank,which coexists with conditions such as Alzheimer's disease and microbleeds,etc.It provides more detailed pathological diagnosis basis for further scientific research sharing of samples.