Objective:To evaluate the effectiveness of an integrated management model involving the Centers for Disease Control and Prevention (CDC), general hospitals, and community health service centers in improving outcomes for community-dwelling patients with chronic obstructive pulmonary disease (COPD), with the aim of optimizing existing COPD management strategies.Methods:This study was a cluster randomized controlled trial. From January to March 2022, a total of 236 patients with COPD were recruited from four communities in Chibi City, Hubei Province. Ultimately, 223 patients completed follow-up and participated in the intervention evaluation. The participants were cluster-randomized into an intervention group ( n=121) and a control group ( n=102). The intervention group received a one-year "trinity" integrated community management model, while the control group received only basic follow-up. Face-to-face questionnaires were administered before and after the intervention to collect data on demographics, disease awareness, risk factors, respiratory symptoms, medication use, and disease management. Quality of life scores and pulmonary function tests were also assessed. Pre-and post-intervention outcomes were compared using t-tests or chi-square tests. Results:The intervention group demonstrated significantly higher rates of COPD awareness and disease-related knowledge compared to the control group (94.12% vs 77.78% and 78.15% vs 49.49%; both P<0.05), along with lower overall smoking rate and current smoking rate (57.14% vs 70.71% and 29.41% vs 47.47%; both P<0.05). The intervention group showed reduced household polluting fuel use for heating (17.65% vs 28.93%; P<0.05), while the control group exhibited no significant change. Significant improvements were observed in the intervention group for inhaler medication usage (14.05% vs 2.94%), exercise training, and respiratory muscle training (22.31% vs 2.94% and 26.45% vs 0.98%)(all P<0.05). Additionally, the intervention group reported lower prevalence of chronic sputum production, wheezing, and dyspnea (12.40%, 0.83%, 27.27% vs 24.51%, 9.80%, 41.18%; all P<0.05) compared to controls. Pulmonary function tests revealed that the percentage of forced expiratory volume in one second (FEV 1%predicted) was significantly higher in the intervention group than in the control group [(69.53±18.01)% vs (54.90±12.39)%; both P<0.05]. Conclusions:The "trinity" integrated management model effectively enhances health literacy, self-management capabilities, and quality of life among COPD patients, while reducing behavioral risk factors. This model aligns with the long-term and individualized management needs of COPD patients.

Objective:To evaluate the effectiveness of an integrated management model involving the Centers for Disease Control and Prevention (CDC), general hospitals, and community health service centers in improving outcomes for community-dwelling patients with chronic obstructive pulmonary disease (COPD), with the aim of optimizing existing COPD management strategies.Methods:This study was a cluster randomized controlled trial. From January to March 2022, a total of 236 patients with COPD were recruited from four communities in Chibi City, Hubei Province. Ultimately, 223 patients completed follow-up and participated in the intervention evaluation. The participants were cluster-randomized into an intervention group ( n=121) and a control group ( n=102). The intervention group received a one-year "trinity" integrated community management model, while the control group received only basic follow-up. Face-to-face questionnaires were administered before and after the intervention to collect data on demographics, disease awareness, risk factors, respiratory symptoms, medication use, and disease management. Quality of life scores and pulmonary function tests were also assessed. Pre-and post-intervention outcomes were compared using t-tests or chi-square tests. Results:The intervention group demonstrated significantly higher rates of COPD awareness and disease-related knowledge compared to the control group (94.12% vs 77.78% and 78.15% vs 49.49%; both P<0.05), along with lower overall smoking rate and current smoking rate (57.14% vs 70.71% and 29.41% vs 47.47%; both P<0.05). The intervention group showed reduced household polluting fuel use for heating (17.65% vs 28.93%; P<0.05), while the control group exhibited no significant change. Significant improvements were observed in the intervention group for inhaler medication usage (14.05% vs 2.94%), exercise training, and respiratory muscle training (22.31% vs 2.94% and 26.45% vs 0.98%)(all P<0.05). Additionally, the intervention group reported lower prevalence of chronic sputum production, wheezing, and dyspnea (12.40%, 0.83%, 27.27% vs 24.51%, 9.80%, 41.18%; all P<0.05) compared to controls. Pulmonary function tests revealed that the percentage of forced expiratory volume in one second (FEV 1%predicted) was significantly higher in the intervention group than in the control group [(69.53±18.01)% vs (54.90±12.39)%; both P<0.05]. Conclusions:The "trinity" integrated management model effectively enhances health literacy, self-management capabilities, and quality of life among COPD patients, while reducing behavioral risk factors. This model aligns with the long-term and individualized management needs of COPD patients.

Objectives:To compare the HbA 1c results on capillary electrophoresis (CE), cation exchange-high performance liquid chromatography (CE-HPLC), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods:902 normal samples without hemoglobin variants and 83 samples with hemoglobin variants were collected in 2020. The variants were divided into α-chain, β-chain, γ-chain, and δ-chain variants. The 902 samples without hemoglobin variants were measured by CE, CE-HPLC, and MALDI-TOF MS. Three methods were used for measuring α-chain, β-chain, and γ-chain compared with the liquid chromatography-tandem mass spectrometry (LC-MS/MS) reference method. According to the EP9-A3 guideline, Passing-Bablok regression and concordance correlation coefficient (CCC) were performed for correlation and consistency, respectively. The imprecision was assessed by coefficient of variance (CV). The mean relative bias was calculated and compared with the lowest biological variation bias of 2.3%.Results:All three methods met the acceptance of imprecision requirements (<2%). The R 2 and CCC for the normal samples were all above 0.95 between the pairwise comparison of CE, CE-HPLC, and MALDI-TOF MS. The mean relative bias between MALDI-TOF MS and CE-HPLC was higher than the lowest biological variation bias of 2.3%. The R 2 results between CE and LC-MS/MS results of α-chain, β-chain, γ-chain variants were>0.95, and the mean relative biases for γ-chain variants exceeded the lowest biological variation bias of 2.3%. A bad correlation ( R2=0.66) for β-chain variants was shown between CE-HPLC and LC-MS/MS and the mean relative biases of all variant samples exceeded 2.3%. MALDI-TOF MS showed good correlations with LC-MS/MS for three groups, and the mean relative biases for γ-chain variants were higher than 2.3%. Conclusion:MALDI-TOF MS and CE-HPLC with CE had good comparability in the measurement of HbA 1c in normal samples, butthe three methods showed interferences from different types of Hb variants and the CE method was affected with less interference.

Objective To analyze differential metabolites (DMs) in the urine of workers with occupational nickel exposure using non-targeted metabolomics, and to screen differential metabolic pathways. Methods A total of 30 nickel exposed workers were selected as the exposure group, and 30 administrative staff from the same factory were selected as the control group using the judgment sampling method. Urine samples of the individuals from the two groups were collected. The ultra-high performance liquid chromatography with quadrupole time-of-flight mass spectrometry and non-targeted metabolomics were used to detect and identify metabolites. The differential metabolic profiles were compared between workers of the two groups, and key differential metabolic pathways and potential biomarkers were screened. The association of DMs and urinary nickel level were evaluated by Spearman correlation coefficients. The sensitivity and specificity of biomarkers were assessed by receiver operating characteristic (ROC) curve analysis. Results A total of 418 metabolites were identified in the urine of worker in the exposure and control groups. The result of principal component analysis and orthogonal partial least squares analysis showed that there were 128 DMs in the urine of workers in the exposure group compared with the control group. These DMs were mainly enriched in glutathione metabolism, carnitine synthesis, and amino acid and nucleotide metabolism pathways, including glycine and serine metabolism. The result of correlation analysis and ROC curve analysis revealed that 4-methylcatechol, 4-vinylphenol sulfate, 2-hydroxyphenylacetone sulfate, 2-dodecylbenzenesulfonic acid, and decylbenzenesulfonic acid could be the potential biomarkers for nickel exposure (all area under the ROC curve >0.800). Conclusion There were significant differences in the urinary metabolic profiles of workers with occupational nickel exposure. The five DMs including 4-methylcatechol, 4-vinylphenol sulfate, 2-hydroxyphenylacetone sulfate, 2-dodecylbenzenesulfonic acid, and decylbenzenesulfonic acid. These DMs could be potential biomarkers of occupational nickel exposure.

Objective:To explore the clinical characteristics and prognosis of metastatic sites symptom as the first manifestation in esophageal carcinoma patients with stage T 1 and T 2, and to provide a reference for clinical practice. Methods:The clinical data of 50 esophageal carcinoma patients with stage T 1 and T 2 who had lymph node or distant metastasis as the first symptom in Anyang Tumor Hospital of Henan Province from November 2007 to December 2019 were retrospectively analyzed. Survival analysis was performed by using Kaplan-Meier method. Univariate analysis was performed by using log-rank test. Results:Among 50 patients with esophageal carcinoma, lymph node metastases as the first symptom were found in 42 cases and distant organ metastases as the first symptom were found in 8 cases. The 1-, 3-, 5-year overall survival rates of patients with stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ were 58.7%, 49.0%, 16.3% and 56.1%, 12.2%, 0, respectively, and there was no statistically significant difference in OS of both groups ( P = 0.094). The 1-, 3-, 5-year overall survival rates of patients with stage N 1 and stage N 2-N 3 were 63.5%, 34.7%, 17.3% and 52.2%, 11.9%, 0, respectively, and there was no statistically significant difference in OS of both groups ( P = 0.083). The 1-, 3-, 5-year overall survival rates were 64.6%, 30.5%, 18.3%, respectively in radiotherapy group and 38.2%, 0, 0, respectively in non-radiotherapy group, and there was a statistically significant difference in OS of both groups ( P = 0.008); the progression-free survival in radiotherapy group was better than that in non-radiotherapy group ( P = 0.028). The 1-, 3-, 5-year overall survival rates were 70.8%, 35.5%, 21.3% and 33.3%, 0, 0 and 35.4%, 0, 0, respectively in concurrent chemoradiotherapy group, radiotherapy group and chemotherapy group, and there was a statistically significant difference in overall survival among three groups ( P = 0.004). The results of univariate analysis showed that radiotherapy ( χ2 = 7.112, P = 0.008) and concurrent chemoradiotherapy ( χ2 = 10.940, P = 0.004) were the main factors affecting the prognosis. Conclusions:Lymph node and distant metastasis could occur in esophageal carcinoma patients with stage T 1 and T 2. Radiotherapy can prolong the progression-free survival time and concurrent chemoradiotherapy could benefit overall survival of these patients.

Objective:To investigate the value of sedation in colonoscopy.Methods:A retrospective cohort study of colonoscopy procedures was performed in our institution. Inclusion criteria: (1) colonoscopy procedures were performed by well-trained gastrointestinal surgeons our institution; (2) medical records were complete and colonoscopy was documented properly by notes, videos, photographs, and traceable pathological reports. Those with incomplete records or performed in other institution were excluded. According to above criteria, clinical data of 49 057 cases of clinic and hospitalization receiving diagnostic or therapeutic colonoscopyat Department of Gastric and Colorectal Surgery, Daping Hospital from July 2007 to February 2017 were collected. Among them, there were 24 638 (50.2%) males and 24 419 females, with mean age of (50.6±14.1) (4 to 98) years. Based on the application of sedation during colonoscopy, patients were divided into the sedation group (39 412 cases, 80.3%) and the non-sedation group (9 645 cases, 19.7%). Clinical characteristics of two groups were compared.Results:The sedation rate increased from 45.6% (369/810) to 94.8% (917/967) from 2007 to 2017. As compared to non-sedation group, a higher proportion of females [51.0% (20 095/39 412) vs. 44.8% (4 324/9 645), χ 2=117.422, P<0.001] and younger median age (50.0 years vs. 51.0 years, Z=-4.774, P<0.001) were found in the sedation group, whose differences were statistically significant. In all the 9645 cases in the non-sedation group, about 5.5% (534) of them terminated the examination because of unbearable discomfort, including 244 (4.6%) males and 290 (6.7%) females (χ 2=20.522, P<0.001). Among all the screening population who were ≥50 years old, there was no significant difference in the polyp detection rate (PDR) between the sedation group and the non-sedation group [26.7% (4 737/17 753) vs. 27.4% (1 093/3 984), χ 2=0.937, P=0.330]. The cecal intubation rate (CIR) in the sedation group was significantly higher than that in the non-sedation group [(85.2% (14 422/16 933) vs. 76.1% (2 803/3 682), χ 2=180.032, P<0.001]. Five cases in the sedation group developed iatrogenic colonic perforation (ICP), with none in the non-sedation group. Conclusions:The application of sedation in colonoscopy is increasingly popular. Sedation can significantly improve CIR in colonoscopy, while it has no positive influence on PDR. Meanwhile, sedation increases the medical expense and may result in higher ICP rate.

Objective:To investigate the value of sedation in colonoscopy.Methods:A retrospective cohort study of colonoscopy procedures was performed in our institution. Inclusion criteria: (1) colonoscopy procedures were performed by well-trained gastrointestinal surgeons our institution; (2) medical records were complete and colonoscopy was documented properly by notes, videos, photographs, and traceable pathological reports. Those with incomplete records or performed in other institution were excluded. According to above criteria, clinical data of 49 057 cases of clinic and hospitalization receiving diagnostic or therapeutic colonoscopyat Department of Gastric and Colorectal Surgery, Daping Hospital from July 2007 to February 2017 were collected. Among them, there were 24 638 (50.2%) males and 24 419 females, with mean age of (50.6±14.1) (4 to 98) years. Based on the application of sedation during colonoscopy, patients were divided into the sedation group (39 412 cases, 80.3%) and the non-sedation group (9 645 cases, 19.7%). Clinical characteristics of two groups were compared.Results:The sedation rate increased from 45.6% (369/810) to 94.8% (917/967) from 2007 to 2017. As compared to non-sedation group, a higher proportion of females [51.0% (20 095/39 412) vs. 44.8% (4 324/9 645), χ 2=117.422, P<0.001] and younger median age (50.0 years vs. 51.0 years, Z=-4.774, P<0.001) were found in the sedation group, whose differences were statistically significant. In all the 9645 cases in the non-sedation group, about 5.5% (534) of them terminated the examination because of unbearable discomfort, including 244 (4.6%) males and 290 (6.7%) females (χ 2=20.522, P<0.001). Among all the screening population who were ≥50 years old, there was no significant difference in the polyp detection rate (PDR) between the sedation group and the non-sedation group [26.7% (4 737/17 753) vs. 27.4% (1 093/3 984), χ 2=0.937, P=0.330]. The cecal intubation rate (CIR) in the sedation group was significantly higher than that in the non-sedation group [(85.2% (14 422/16 933) vs. 76.1% (2 803/3 682), χ 2=180.032, P<0.001]. Five cases in the sedation group developed iatrogenic colonic perforation (ICP), with none in the non-sedation group. Conclusions:The application of sedation in colonoscopy is increasingly popular. Sedation can significantly improve CIR in colonoscopy, while it has no positive influence on PDR. Meanwhile, sedation increases the medical expense and may result in higher ICP rate.

Through checking the ancient books and the articles at the modern times and combining the disciplinary characteristics of techniques of acupuncture and moxibustion, the training of manipulation skills was discussed. It is proposed that during the teaching of the techniques of acupuncture and moxibustion, the most basic ability of needling technique should be trained in the first place. This ability includes the ability of spiritual cultivation, the ability of tactile perception and the specific training for the needling techniques. The ability of spiritual cultivation refers to the consciousness concentration to the patient when providing acupuncture, which may promotes and conducts to the affected area. The ability of tactile perception refers to the different feelings of different tissues under the hands before and after acupuncture, the perception to the different needling sensations corresponding to the chief complains of patients as well as the different body responses after acupuncture. In order to ensure the better learning results, the specific manipulations of needling techniques should be provided accordingly on the base of these basic training skills of acupuncture.
Acupuncture ; education ; Books ; Learning ; Moxibustion ; Teaching

The etiology of hemophagocytic lymphohistiocytosis (HLH) is complicated and difficult to diagnose, unexplained HLH often with hematological malignancies. Invasive biopsy can help to find etiology, the results may be affected by the technique and the location of the puncture site. Multiangle puncture can improve the success rate, but the corresponding risk increases. A patient with HLH was admitted to Affiliated Hospital of Zunyi Medical College. The etiology was unknown. Active symptomatic support treatment was conducted, at the same time, finding the evidence of viral infection, autoimmune disease related detection, blood culture, bone marrow puncture smear and spleen biopsy were performed respectively to find the pathogen basis. Spleen hemorrhage was not being controlled after spleen biopsy in patients, and emergency splenectomy was adopted to stop bleeding for saving lives. Finally, the patients died of low protein, pulmonary edema and respiratory failure. The bone marrow puncture and spleen biopsy failed to provide the basis for tumor invasion, while the spleen pathological slices plus immunohistochemical indicate diffuse large B cell lymphoma (DLBCL) after splenectomy, which was identified as malignant tumor-associated hemophagocytic syndrome. Underscoring the high risk of bleeding after tumor-associated splenomegaly puncture and the importance of having emergency plans. Through analyzing the clinical characteristics, diagnosis and treatment of this patient, we hope to improve the clinicians' understanding of HLH and lymphoma.

Pituitary stalk interruption syndrome (PSIS) is a newly discovered rare endocrinological syndrome characterized by structrual defect of pituitary and multiple deficiencies of a series of hypothalamic hormones, and thus leading to a cluster of clinical symptoms. This review will illustrate the genetic pathogenic factors influence on embryonic development, and briefly introduce the current studies of Whole-Exome Sequencing on PSIS.