Objective:To observe the clinical efficacy of transcranial direct current stimulation(tDCS)and tDCS com-bined with mirror therapy in the treatment of shoulder-hand syndrome after stroke.Method:Forty-five patients with post-stroke shoulder-hand syndrome were divided into the combined group,tDCS group and the conventional group,with 15 cases in each group.In the combined group,tDCS combined with mirror therapy was added on the basis of routine rehabilitation.The tDCS group added tDCS treatment on the ba-sis of routine rehabilitation treatment.The conventional group received routine rehabilitation treatment.The treat-ment lasted for 10 days.Before and after treatment,shoulder-numerical rating scale(S-RNS),hand-numerical rating scale(H-RNS),edema degree of affected hand,Fugl-Meyer assessment of upper extremity(FMA-UE),modified bar-thel index(MBI)and shoulder-hand syndrome scale(SHSS)were used to evaluate patients in the three groups.Result:Compared with before treatment,the S-NRS,H-NRS score,hand edema degree,FMA-UE,MBI and SHSS score in the combined group and tDCS group were significantly improved(P<0.05)after treat-ment,while the H-NRS score in conventional group was significantly improved(P<0.05).After the treatment,the shoulder-NRS score of the combined group was significantly decreased and the SHSS and MBI score were also significantly increased,compared with that of the tDCS and conventional group(P<0.05).The MBI score of the tDCS group was significantly increased compared with the conventional group(P<0.05).Conclusion:tDCS can improve the clinical symptoms of post-stroke SHS,the combination of mirror therapy is more effective.

Objective:To observe the clinical efficacy of transcranial direct current stimulation(tDCS)and tDCS com-bined with mirror therapy in the treatment of shoulder-hand syndrome after stroke.Method:Forty-five patients with post-stroke shoulder-hand syndrome were divided into the combined group,tDCS group and the conventional group,with 15 cases in each group.In the combined group,tDCS combined with mirror therapy was added on the basis of routine rehabilitation.The tDCS group added tDCS treatment on the ba-sis of routine rehabilitation treatment.The conventional group received routine rehabilitation treatment.The treat-ment lasted for 10 days.Before and after treatment,shoulder-numerical rating scale(S-RNS),hand-numerical rating scale(H-RNS),edema degree of affected hand,Fugl-Meyer assessment of upper extremity(FMA-UE),modified bar-thel index(MBI)and shoulder-hand syndrome scale(SHSS)were used to evaluate patients in the three groups.Result:Compared with before treatment,the S-NRS,H-NRS score,hand edema degree,FMA-UE,MBI and SHSS score in the combined group and tDCS group were significantly improved(P<0.05)after treat-ment,while the H-NRS score in conventional group was significantly improved(P<0.05).After the treatment,the shoulder-NRS score of the combined group was significantly decreased and the SHSS and MBI score were also significantly increased,compared with that of the tDCS and conventional group(P<0.05).The MBI score of the tDCS group was significantly increased compared with the conventional group(P<0.05).Conclusion:tDCS can improve the clinical symptoms of post-stroke SHS,the combination of mirror therapy is more effective.

Objective:To investigate the effect of vitamin D supplementation on weight loss efficacy and insulin resistance (IR) in obese patients.Methods:It was a randomized controlled trial. A total of 190 obese patients with vitamin D deficiency were selected from the obesity clinic of Tianjin Union Medical Center from March to December in 2023. The patients were divided into control group (95 cases) and vitamin D group (95 cases) according to random number table. The control group was given energy-limited high-protein diet combined with moderate intensity exercise, and the vitamin D group was supplemented with vitamin D on the basis of the control group, 14 000 U/week for 24 weeks. A total of 25 dropped out of the study from the two groups for various reasons. Finally, 79 cases in the control group and 86 cases in the vitamin D group were included in the analysis. Independent sample t test and rank sum test were used to compare serum 25 hydroxyvitamin D [25 (OH) D] level, body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin and glycated hemoglobin (HbA 1c) between the two groups at baseline and after intervention. Homeostasis model insulin resistance index (HOMA-IR) was used to evaluate the degree of insulin resistance (IR), and the effects of vitamin D supplementation on weight loss efficiency and IR in those patients were analyzed. Results:There was no significant differences in serum 25(OH)D level between the two groups before intervention ( P>0.05); the serum 25(OH)D level in the vitamin D group was significantly higher than that in the control group after intervention [(30.90±7.55) vs (16.00±4.34) μg/L] ( t=-15.35, P<0.001). The body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin, HbA 1c, and HOMA-IR were all significantly lower after the intervention than those before the intervention in both groups [control group: (93.32±13.47) vs (98.95±14.31) kg, (33.74±5.09) vs (35.80±5.52) kg/m 2, (39.77±11.87) vs (44.12±12.79) kg, (183.76±40.95) vs (204.01±32.18) m 2, 5.00 (4.55, 5.67) vs 5.24 (4.68, 6.42) mmol/L, 16.78 (13.94, 24.30) vs 22.56 (15.95, 31.2) mU/L, 5.55%±0.53% vs 6.05%±0.99%, 4.11 (3.14, 5.57) vs 5.51 (3.61, 8.49); vitamin D group: (88.14±17.66) vs (104.43±22.02) kg, (31.02±5.10) vs (36.66±5.98) kg/m 2, (35.51±12.87) vs (46.67±13.33) kg, (166.50±49.50) vs (213.64±40.14) m 2, 4.70 (4.35, 5.07) vs 5.17 (4.77, 6.30) mmol/L, 13.18 (9.87, 18.84) vs 21.67 (15.78. 32.74) mU/L, 5.43%±0.48% vs 6.21%±1.22%, 2.88 (1.99, 4.21) vs 5.19 (3.82, 9.27)], and the body weight, body mass index, adiposity, visceral fat area, fasting blood glucose, fasting insulin, and HOMA-IR were all significantly lower in vitamin D group than those in the control group [(88.14±17.66) vs (93.32±13.47) kg, (31.02±5.10) vs (33.74±5.09) kg/m 2, (35.51±12.87) vs (39.77±11.87) kg, (166.50±49.50) vs (183.76±40.95) m 2, 4.70 (4.35, 5.07) vs 5.00 (4.55, 5.67) mmol/L, 13.18 (9.87, 18.84) vs 16.78 (13.94, 24.30) mU/L, and 2.88 (1.99, 4.21) vs 4.11 (3.14, 5.57), respectivley] (all P<0.05). The IR remission rate was significantly higher in the vitamin D group than that in the control group after the intervention (37.3% vs 15.3%) ( χ2=8.071, P=0.002). Conclusion:Supplementation of vitamin D on the basis of energy-limited high-protein diet combined with moderate intensity exercise can significantly improve the efficacy of weight loss and IR in obese patients with vitamin D deficiency.

We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.

Nursing information security is an essential component of providing high-quality nursing services and is an important guarantee for the construction of large-scale health care data application systems. This article reviewed the concept, assessment tools, and influencing factors of nursing information security, aiming to provide references for hospital nursing managers to effectively assess information security and improve nurses′ information literacy.

Objective:To construct a new model for assessing insulin resistance(IR) in newly diagnosed type 2 diabetic patients by combining anthropometry parameters and biochemical parameters.Methods:A total of 677 newly diagnosed type 2 diabetic patients were included in this study. Clinical data, biochemical indicators, and body composition measurements were collected, and a predictive model was constructed using logistic regression analysis.Results:The IR prediction model was constructed based on five indicators: triglycerides(TG), fasting plasma glucose(FPG), visceral fat area(VFA), alanine aminotransferase(ALT), and uric acid(UA). The formula for the new predictive model was as follows: y=-17.765+ 1.389×ln VFA+ 1.045×ln UA+ 0.91×ln ALT+ 2.167×ln FPG+ 0.805×ln TG. The receiver operating characteristic curve(ROC) area under the curve(AUC) for the model was 0.82, with an optimal cutoff value of 1.67, sensitivity of 0.80, and specificity of 0.71. The AUC values for the triglyceride glucose(TyG) index, lipid accumulation product(LAP), and triglyceride/high-density lipoprotein cholesterol ratio(THR) were 0.75, 0.75, and 0.70, respectively. The corresponding sensitivities were 0.66, 0.84, and 0.71, and the specificities were 0.71, 0.59, and 0.60. The optimal cutoff values were 1.81, 30.31, and 1.14, respectively. Conclusion:The new model constructed using TG, FPG, VFA, ALT, and UA as indicators showed high predictive value and can serve as a new model for assessing IR in newly diagnosed type 2 diabetic patients.

Humans ; Intra-Abdominal Fat/diagnostic imaging* ; Coronary Artery Disease ; Body Mass Index

Objective: This is a study to evaluate complication rate, satisfaction and quality of life after breast reconstruction under different classifications. The classification criteria are the timing of operation, surgical procedures, and patients′age. Methods: By reviewing the surgical cases from August 2004 to June 2018, the authors summarized the data of 102 patients with breast reconstruction of the same surgeon in Peking University People′s Hospital and Plastic Surgery Hospital (Institute) CAMS PUMC. Fifty-four patients who met the inclusion criteria and completed the BREAST-Q breast reconstruction module scale, were divided into immediate group or delayed group, according to the timing of operation; divided into abdomen group or other procedures group, according to the surgical procedure; and divided into the young patients′group or senior patients′group according to age. The index were (1) postoperative complication rate, (2)satisfaction with breasts, psychosocial well-being, physical well-being of chest and abdomen, sexual well-being, satisfaction with outcome, satisfaction with information, satisfaction with care (based on the BREAST-Q scale). Results: Complication rate was 9.1%(1/11) in the immediate group, 16.3%(7/43) in the delayed group, 14.7%(5/34) in the abdomen group, 15.0%(3/20) in other procedures group, 13.6%(3/22) in the young patients′group, and 15.6%(5/32) in the senior patients′group. There was no significant difference in the incidence of complications (P>0.05). The postoperative scores of satisfaction with breasts, psychological well-being and sexual well-being were significantly higher in the immediate group than in the delayed group(P=0.026, P<0.001 and P=0.001, respectively). The score of postoperative physical well-being of chest was significantly higher in the abdomen group than other procedures group(P=0.020). The score physical well-being of abdomen was lower compared with the preoperative in the abdomen group (P<0.001). The score of physical well-being of abdomen was lower in the senior patients′group than that of the young patients′group (P=0.010). Conclusions The complication incidence of breast reconstruction patients was similar among different groups. The breast reconstruction surgery can significantly improve satisfaction and quality of life of patients. To some extent, immediate breast reconstruction can reduce the psychological and physiological effects of breast loss on patients, leading to higher postoperative satisfaction. Breast reconstruction with abdominal flaps can provide patients with better chest health but poor abdomen health. Although elderly patients undergoing breast reconstruction will have poor physical well-being of abdomen, they can still achieve higher satisfaction of operation.

Objective: To evaluate the safety, reliability and effectiveness of "free style endoscopic technique" assisted transaxillary high level dual plane breast augmentation; To explore endoscopic techniques that can achieve higher efficiency and better result ; To discover a safe and effective method for dual plane dissection with the help of endoscopy. Methods: Using new endoscopic techniques to perform transaxillary dual plane breast augmentation: ① High level dual plane technique, the muscle division line is about 1.5 cm higher than the original inferior mammary fold, the cephalic side of the muscle is retracted to the lower border of the areola with a special retractor to form a high level dual plane cavity, thus the upper and lower portion of the implant would be covered by pectorilis major muscle, while the rest of the implant was partially under breast parenchyma. ② "Free style endoscopic techniques" , the endoscopy and retractor are not fixed to each other, thus the space is exposed by an assistant with a new designed special retractor, while the operator is concentrate on dissecting with endoscopy in one hand and long tipped bowie in the other hand. ③ Accurate navigate technique, define the dissection border by acupuncture via skin in a 90 degree angle, thus to make the dissection right as preoperative design. Results: There were 1 106 cases underwent this kind of surgery, while 405 of them, whose minimum follow up were 12 months were included in this retrospective study. The follow up period ranged from 12-60 months, the average follow up period is 24.3 months. The average operation time is (1.47 ±0.46) h, the average drainage removal time is (4.23±0.51) d after surgery. The perioperative complication rate is 0.99%, including an incision site change caused by intraoperative bleeding, 1 case of pneumothorax, 2 cases of bleeding after surgery. Long period complication including: 6 cases (1.48%) Ⅲ grade capsular contracture, 21 cases (5.20%) of nipple-areola sensation disorders, implant palpable occurred in 14 case (3.46%), 3 cases (0.74%) implant malposition, 2 cases (0.49%) implant distortion, the total reoperation rate is 2.47%. There was no infection, hematoma, seroma, curtain deformity, double bubble deformity occurred in our study. Conclusions The high level dual plane techniques not only can solve the deficient soft tissue coverage problem thus to lower the rate of implant palpability, but also can relieve the relationship of the pectorilis major muscle and the inframammary fold(IMF), offering an option to replace Ⅱ and Ⅲ type of dual plane techniques, decrease the risk of curtain deformity and double bubble deformity. The free style endoscopic techniques are very flexible and efficient, with the help of accurate navigate technique, it can archive an accurate cavity dissection, accurate and definite IMF, and a lower complication rate. Though the learning curve is relatively longer, it is really a safe and effective breast augmentation method worthwhile to learn and spread.

Objective To explore the operation procudure and notice of establishing a rat model of abdominal heterotopic heart transplantation by single operator,and summarize the detailed skill and experience for beginners.Methods 68 pairs male SD(recipients)/Wistar(donors) rats,preoperative anesthesia for recipients and donors at the same time,8/0 line was preparing for blocking recipients vena cava and abdominal aortic,blocking the branch vessel.Left and right superior vena ligature respectively with hilar,cutting the ascending aorta,perfusion cardioplegia,free pulmonary artery,across transverse sinus of pericardium for pulmonary artery cutting,atrial wash,free donor heart.Choosed appropriate incision of receptor abdominal blood vessels,mattress suture at 6 and 12 points,a single suture for vent gases,continuous suture in artery,single needle in vein,reperfusion after exhaust gas.Recording operation time,HE staining,IL-1β/CD3 immunohistochemistry slice,flow cytometry analysis of CD4+T/CD8+T lymphocytes subsets in the peripheral blood.Results Sixty-eight cases were treated by single operater,the operation time was(58.8±4.5)minutes,artery suture time was(7.6±2.2)minutes,vein suture time was(13.5±4.2)minutes,the total donor heart ischemic time was(31.8±4.5)minutes,the success rate was 88.2％.The rejection reaction was stronger on the third and fifth day after surgery,with high expression of IL-1β/CD3 in cardiac allografts.The CD4+T/CD8+T lymphocytes subsets increased in the peripheral blood at first day after heart transplantation.Conclusion By fully preparation and skillfully operation,establishing a rat model of abdominal heterotopic heart transplantation by single operator has a stable success rate.