Objective To explore the trajectory of disability acceptance and the factors influencing it in first stroke patients.Methods A total of 202 first-ever stroke patients admitted to Wenzhou Central Hospital from December 2022 to December 2023 were selected,low acceptance group(n=38),medium acceptance group(n=96),and high acceptance group(n=68)based on the trajectory of disability acceptance after discharge.Multivariate Logistic regression was applied to explore the factors affecting disability acceptance in first-episode stroke patients.Results The total score of acceptance of disability scale-revised(ADS-R)in stroke patients was(89.93±13.51)points.There were differences between three groups in terms of age,education level,family income,caregiver or no caregiver,severity of illness,medical social support scale(MOS-SSS)scores,herth hope index(HHI)scores,and patient health questionnaire depression scale-9 scores(P＜0.05).Multivariate Logistic regression analysis reveled that age(OR=12.419,95％CI:3.967-38.882),absence of caregiver(OR=5.793,95％CI:1.989-16.875),severity of the condition(OR=5.724,95％CI:1.927-16.999)were risk factors affecting disability acceptance in first-episode stroke patients(P＜0.05),while educational level(OR=0.207,95％CI:0.069-0.624),household income(OR=0.238,95％CI:0.079-0.712),and MOS-SSS score(OR=0.502,95％CI:0.303-0.832)were protective factors(P＜0.05).Conclusion There are three different trajectories of disability acceptance in first-episode stroke patients.Age,presence or absence of caregivers,severity of the condition,education level,household income,and MOS-SSS score are influencing factors of disability acceptance in first-episode stroke patients and can be used as predictive factors for disability acceptance trajectories.

Objective The core competence index system of nurses providing"internet+postpartum maternal and infant home care"service was constructed and preliminarily verified,so as to provide references for objective evaluation of their core competence.Methods Based on literature review and semi-structured interviews,the core competence index system of nurses in"internet+postpartum maternal and infant home care"service was initially constructed with the iceberg model as the theoretical framework.In April to May 2024,the indicators are organized and analyzed using the Delphi method to form a final indicator system.In December 2024,30 nurses providing"internet+postpartum maternal and infant home care"service in a tertiary A obstetrics and gynecology hospital in Hangzhou were selected as the survey subjects,and the index system was preliminarily verified by questionnaires.Results A total of 20 experts completed 2 rounds of correspondence.The authoritative coefficients of the 2 rounds of expert inquiry were 0.88 and 0.90,respectively;the Kendall coordination coefficients were 0.34 and 0.39,respectively(P＜0.001);the variation coefficients were 0～0.17 and 0.05～0.18,respectively.The final index system includes 3 first-class indicators,12 second-class indicators and 68 third-class indicators.The comprehensive,specialized,necessary,applicable,and overall satisfaction scores of the indicator system are(4.27±0.77)points,(4.43±0.56)points,(4.43±0.72)points,(4.47±0.56)points,and(4.46±0.56)points,respectively.Conclusion The core competence index system of nurses in"internet+postpartum maternal and infant home care"service is comprehensive,specialized,scientific and reliable,and can provide references for the training,assessment and evaluation of"internet+postpartum maternal and infant home care"talents.

Objective To explore the influencing factors of olfactory dysfunction in patients with Parkinson's disease(PD)and conduct a systematic review and Meta-analysis.Methods Articles on factors influencing olfactory dysfunction in PD were retrieved from databases including SinoMed,VIP,China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,Web of Science,PubMed,Cochrane,Embase,and MEDLINE.The search period spanned from the inception of each database to November 30,2024.Results A total of 13 articles(with a total sample size of 2465)were included,with a total of 18 influencing factors summarized as two themes:core features and progression factors of PD,and individual background and environmental interaction factors.Meta-analysis showed that age(MD=1.01,95％CI:-0.46-2.49,P=0.18),smoking(OR=0.88,95％CI:0.57-1.37,P=0.57),and constipation(OR=1.22,95％CI:0.38-3.93,P=0.74)were not factors affecting olfactory dysfunction in PD patients.Conclusion Factors influencing olfactory dysfunction in PD are predominantly associated with non-motor symptoms.Intervention strategies targeting non-motor symptoms(such as improving sleep quality,vitamin D supplementation,and early cognitive training)may provide novel approaches for delaying the progression of olfactory dysfunction.

Objective:To explore the impact of National Metabolic Management Center (MMC) mode on the metabolic indexes in different age patients with type 2 diabetic mellitus (T2DM).Methods:A prospective study method was used. A total of 798 T2DM patients underwent the MMC mode management in Shanghai Punan Hospital of Pudong New District from May 2021 to August 2024 were selected. The patients followed the MMC one-stop diagnosis and treatment management service standards to enter the registration, treatment, examination and follow-up processes. The average follow-up time was 12.0 months. The glucose and lipid metabolism indexes, blood pressure and body mass index (BMI) before intervention and after receiving the intervention by MMC were measured. The glucose and lipid metabolism indexes included triacylglycerol, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin. The control rates of blood glucose, blood lipid, blood pressure and BMI were calculated after intervention.Results:The triacylglycerol, total cholesterol, LDL-C, fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin after intervention in patients with T2DM were significantly lower than those before intervention: (1.75 ± 1.63) mmol/L vs. (2.08 ± 1.74) mmol/L, (4.37 ± 1.11) mmol/L vs. (4.88 ± 1.24) mmol/L, (2.47 ± 0.92) mmol/L vs. (2.92 ± 0.98) mmol/L, (6.54 ± 1.71) mmol/L vs. (8.12 ± 3.05) mmol/L, (9.04 ± 3.49) mmol/L vs. (12.10 ± 5.28) mmol/L and (6.89 ± 1.23)% vs. (8.85 ± 2.31)%, the HDL-C after intervention was significantly higher than that before intervention: (1.21 ± 0.31) mmol/L vs. (1.13 ± 0.29) mmol/L, and there were statistical differences ( P<0.01). The control rates of blood lipid and blood glucose after intervention in patients with T2DM were significantly higher than those before intervention: 54.6% (436/798) vs. 37.3% (298/798) and 62.0% (495/798) vs. 26.1% (208/798), and there were statistical differences ( P<0.01); there were no statistical differences in the control rates of BMI and blood pressure before intervention and after intervention ( P>0.05). In T2DM patients with age <50 years and from 50 to 59 years, the triacylglycerol, total cholesterol, LDL-C, fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin after intervention were significantly lower than those before intervention, the HDL-C after intervention was significantly higher than that before intervention, and there were statistical differences ( P<0.05 or <0.01); the control rates of blood lipid and blood glucose after intervention were significantly higher than those before intervention, the patients with <50 years: 44.5% (114/256) vs. 27.7% (71/256) and 76.6% (196/256) vs. 28.9% (74/256), the patients with 50 to 59 years: 54.8% (86/157) vs. 28.0% (44/157) and 66.9% (105/157) vs. 24.8% (39/157), and there were statistical differences ( P<0.01); there were no statistical differences in the control rates of BMI and blood pressure between before intervention and after intervention ( P>0.05). In T2DM patients with age from 60 to 69 years, the triacylglycerol, total cholesterol, LDL-C, fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin after intervention were significantly lower than those before intervention, and there were statistical differences ( P<0.05 or <0.01); there was no statistical differences in HDL-C before intervention and after intervention ( P>0.05); the control rates of blood lipid and blood glucose after intervention were significantly higher than those before intervention: 59.0% (177/300) vs. 47.3% (142/300) and 53.3% (160/300) vs. 25.7% (77/300), and there were statistical differences ( P<0.01); there were no statistical differences in the control rates of BMI and blood pressure before intervention and after intervention ( P>0.05). In T2DM patients with aged ≥70 years, the total cholesterol, LDL-C, 2 h postprandial blood glucose and glycated hemoglobin after intervention were significantly lower than those before intervention, and there were statistical differences ( P<0.05 or <0.01); there were no statistical difference in triacylglycerol, HDL-C and fasting blood glucose between before intervention and after intervention ( P>0.05); the control rate of blood glucose after intervention was significantly higher than that before intervention: 48.2% (41/85) vs. 22.4% (19/85), and there was statistical difference ( P<0.01); there were no statistical differences in the control rates of BMI, blood pressure and blood lipid between before intervention and after intervention ( P>0.05). Conclusions:The intervention based on MMC mode management could effectively improve the glucose and lipid metabolism in patients with T2DM, especially for patients with aged <70 years. However, additional health guidance is needed for patients with aged ≥ 70 years to further enhance their health benefits.

Objective To investigate the protective effects of remimazolam(Remi),a novel benzodiazepine sedative,on intestinal barrier function in septic mice.Methods A mouse model of sepsis was established using cecal ligation and puncture(CLP).A total of 96 SPF-grade adult male C57BL/6 mice were randomized into sham operation(Sham),sepsis(Sepsis),and sepsis with Remi intervention(Sepsis+Remi)groups.Survival rate and survival time were recorded within 72 h after modeling.Intestinal pathological alterations,barrier functional indicators,ZO-1 expression,and macrophage polarization status were observed and detected to evaluate the effects of Remi.Lipopolysaccharide(LPS)was used to treat RAW264.7 cells for 24 h to simulate in vitro sepsis model.The cells were divided into control(Control),LPS,and LPS+Remi groups.Immunofluorescence staining was performed to assess macrophage phenotype,mitochondrial morphology,and mitochondrial reactive oxygen species(MtROS),and Western blotting was applied to detect the protein expression of iNOS and CD206.Results Compared with the sepsis group,Remi intervention significantly improved the survival rate of septic mice from 12.50%to 68.75%and markedly prolonged survival duration(P<0.05).Histopathological analysis demonstrated partial restoration of intestinal villus architecture,accompanied with attenuated interstitial edema and reduced inflammatory cell infiltration after Remi intervention.Furthermore,the intervention group demonstrated significant improvement in functional indicators.Both in vivo and in vitro experiments demonstrated elevated iNOS and decreased CD206 expression in the septic mice and LPS-stimulated macrophages(P<0.05),which were partially reversed after Remi intervention.Furthermore,LPS-stimulated macrophages exhibited fragmented mitochondria and elevated MtROS level,whereas Remi intervention ameliorated these conditions(P<0.05).Conclusion Remi protects intestinal barrier function in septic mice by mitigating mitochondrial dynamics imbalance-induced oxidative damage and ameliorating inflammatory macrophage activation.

Objective:To explore the clinical characteristics of neonatal necrotizing enterocolitis（NEC）and analyze the risk factors for early-onset NEC.Methods:A total of 220 children with NEC admitted to the Department of Pediatrics，Tianjin Medical University General Hospital from January 1st，2018 to February 29th，2024 were retrospectively selected as the research objects. According to the time of onset，the early-onset group（ n=120）and the late-onset group（ n=100）were established，and the clinical characteristics of the two groups were compared. Another 150 cases of normal healthy newborns born in this hospital in the same period were selected as the control group，and the clinical data of the control group were collected. The clinical characteristics of the early-onset group and the control group were compared，and the risk factors of early-onset NEC were analyzed by multivariate Logistic regression. Results:Compared with the late-onset group，the early-onset group had fever［50.0%（60/120）vs. 40%（40/100）， χ2=7.333， P=0.007］，apnea［39.17%（47/120）vs. 28%（28/100）， χ2=7.568， P=0.006］，no rise in body temperature［56.67%（68/120）vs. 39%（39/100）， χ2=6.815， P=0.009］，abdominal distension［25%（30/120）vs. 40%（40/100）， χ2=13.200， P<0.001］，vomiting［30.83%（37/120）vs. 45%（45/100）， χ2=12.797， P<0.001］was significantly different（all P<0.05）；Multivariate Logistic regression analysis：weight<1 500 g（ OR=5.871，95% CI：3.153～9.673， P<0.001），gestational age<30 weeks（ OR=4.256，95% CI：2.641～7.896， P=0.007），hemodynamically significant patent ductus arteriosus（hs-PDA）（ OR=3.113，95% CI：1.865～5.133， P=0.033），severe anemia（ OR=3.057，95% CI：2.165～4.802， P=0.001），feeding intolerance（ OR=4.215，95% CI：1.579～10.802， P=0.005），amniotic fluid pollution（ OR=2.452，95% CI：1.579～3.111， P<0.001）were the independent risk factors for early-onset NEC（all P<0.05）. Conclusion:Weight<1 500 g，gestational age<30 weeks，hs-PDA，severe anemia，feeding intolerance，and amniotic fluid contamination are independent risk factors for early-onset NEC. In clinical practice，more attention should be paid to these factors for disease prevention，early identification，and timely intervention in newborns to reduce the occurrence of NEC.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To investigate the clinicopathological characteristics and diagnosis of high-grade succinate dehydrogenase-deficient renal cell carcinoma (SDH-RCC).Methods:Three cases of high-grade SDH-RCC diagnosed by immunohistochemical staining and/or molecular testing were collected from Affiliated Hospital of Qingdao University and 971 Hospital of Navy of Chinese People′s Liberation Army from January 2015 to December 2023. The clinicopathological characteristics and immunohistochemical features were summarized using light microscopy. Two cases were tested for gene mutations by next-generation sequencing.Results:Of the 3 cases, 2 were male and 1 was female. The ages were 49, 61, and 53 years, respectively. Gross examination revealed that all tumors were single nodules with diameters of 7.0, 4.5, and 5.2 cm, respectively, grayish white in color with irregular borders. Cases 1 and 2 exhibited solid cut sections, whereas case 3 had cystic and solid cut sections. Microscopically, all cases had high WHO/ISUP nuclear grade (3 or 4) and overt invasion. Case 1 exhibited a solid, sheet-like growth pattern with numerous scattered glandular ducts or acinar structures. Case 2 displayed a diffusely growth pattern reminiscent of sarcoma. Case 3 demonstrated intracystic papillary and nodular infiltrative growth patterns. Large clear cytoplasmic vacuoles could be observed in the focal areas of case 1 and case 3. Prominent peritumoral lymphocytes in stroma were noted in case 1. Case 1 was diagnosed with regional lymph node metastasis, and case 2 was diagnosed with renal vein thrombosis. Immunohistochemical staining revealed that SDHB and SDHA were deficiently expressed in 3 cases, while PAX8, FH, and INI-1 exhibited diffuse expression. CD10 (1/3), CA9 (1/3), and CK20 (1/3) were occasionally expressed. The Ki-67 proliferation index ranged from 10% to 50%. Two cases underwent next-generation sequencing and were both found to harbor pathogenic mutations in SDHA (case 2 had a frameshift mutation, and case 3 had a splice site mutation). All 3 cases were followed up for 11 to 112 months. Case 2 died 11 months post-operation, while case 1 and case 3 survived for 19 and 112 months, respectively, without any recurrence or metastasis.Conclusions:High-grade SDH-RCC is a rare subtype of SDH-RCC. The tumor exhibits various architectural patterns and is often misdiagnosed as other types of renal cell carcinoma. The presence of cytoplasmic vacuoles may be indicative for diagnosis. Compared to typical SDH-RCC, the high-grade subtype generally shows a larger tumor size, higher TNM stage, greater invasive potential, and poorer prognosis. For high-grade SDH-RCC, routine SDHB immunohistochemical staining may be necessary. The occurrence of high-grade SDH-RCC may be associated with mutations in SDHA.

Objective:To analyze the current status and influencing factors of balance ability in elderly inpatients, and to explore the correlation between balance function and the tendency to suffer from geriatric syndromes.Methods:A total of 262 elderly patients hospitalized from April to August 2023 were selected as the research objects by convenience sampling method.A systematic health assessment was performed by professional evaluators using the "Edge Intelligent Geriatric Assessment System" software of the Jiangsu Province Hospital within one week after admission.According to the results of Performance Oriented Mobility Assessment(POMA), the subjects were divided into normal balance group(n=188), POMA score 19 to 24 group(n=36)and less than 19 score group(n=38), the differences in the tendency of the three groups of patients to develop geriatric syndromes were compared.Logistic regression analysis was used to screen the related factors and construct the regression equation.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of regression equation.Results:A total of 262 patients, of which 156(59.54%)were males, with an age range of 60 to 100 years(mean age 74.11±8.77 years)were included in the study.The total POMA score of 262 patients was 23.69±6.00, of which 74 cases(28.24%)had balance dysfunction.Univariate analysis showed that there were significant differences in age( t=20.356, P<0.001), serum albumin( t=3.999, P=0.019), proportions of people suffering from depression, frailty, sarcopenia, sleep disorders, nutrition risk and high fall risk between patients with different balance ability( χ2=10.250, 76.763, 101.728, 37.805, 22.472, 75.095, all P<0.05).Binary logistic regression model showed that age, sarcopenia, suspected insomnia, insomnia, and nutritional risk were independent predictors of balance ability in elderly patients(OR=1.071, 12.424, 6.719, 8.321, 3.440, all P<0.05).The above related variables were included in the regression equation: Logit(P)=-8.792+ 0.069×age+ 2.520×sarcopenia+ 1.905×suspected insomnia+ 2.119×insomnia+ 1.236×nutritional risk.ROC curve analysis showed that the area under the curve(AUC)was 0.902(95% CI: 0.857-0.946, P<0.001), the predictive specificity was 86.17% and the sensitivity was 85.14%. Conclusions:Age≥75.5 years, sarcopenia, sleep disorders, and nutritional risk could be used as predictors of balance disorders in elderly inpatients.The regression model constructed based on these indicators has a good predictive value.The establishment of the edge intelligent geriatric assessment system promotes the improvement of medical information level.