With the rise of digital healthcare in recent years, digital tools, as a new type of health management tool, are expected to become a feasible tool for rehabilitation exercise in stroke patients. The aim of this article is to review the current status of the application of digital tools in self-management of stroke recovery. In addition, the concept, function and application effect of digital tools are introduced, and the existing problems and future research directions are pointed out, in order to provide reference for the self-management of stroke patients in China.

Objective To explore the serum placental growth factor (PlGF) and triggering receptors expressed on myeloid cell-1 (TREM1)levels in patients with diabetes foot,and the correlation between them and clinical grading and prognosis of patients. Methods From January 2021 to January 2023,97 patients with diabetes foot who were admitted to Affiliated Hospital of Guilin Medical University were collected as the study object (diabetes foot group),and 102 healthy people who were examined in the hospital were collected as the healthy control group. The patients with diabetic foot were categorized into 33 cases of grade 0～1,39 cases of grade 2～3,and 25 cases of grade 4～5 according to Wanger grading criteria. Patients with diabetes foot were followed up for 6 months and divided into good prognosis group (n=72) and poor prognosis group (n=25).Serum PlGF and TREM1 levels were compared between groups. Spearman correlation analysis was applied to explore the correlation between serum PlGF and TREM1 levels and clinical grading in patients,factors influencing the prognosis of patients with diabetic foot was analyzed by Logistic regression . Receiver operating characteristic (ROC) curve was applied to investigate the predictive effect of serum PlGF and TREM1 on the prognosis of patients with diabetes foot. Results The expression level of serum PlGF in the diabetes foot group was lower than that in the healthy control group (53.86±15.13 pg/ml vs 87.57±18.28 pg/ml),and the level of TREM1 was significantly higher than that in the healthy control group (279.56±32.25 ng/L vs 195.37±26.28 ng/L),and the difference was statistically significance (t=14.133,20.232,all P<0.05).Serum PlGF expression (39.41±13.28 pg/ml vs 66.13±16.30 pg/ml,52.75±15.32 pg/ml) was lower in patients with clinical grades 4～5 than in patients with grades 0～1 and 2～3. TREM1 expression (326.66±35.75 ng/L vs 248.21±29.83 ng/L,275.89±32.06 ng/L) was higher than in patients with grades 0～1 and 2～3. Serum PlGF expression was lower in patients with clinical grades 2～3 than in patients with grades 0～1. TREM1 expression was higher than in patients with grades 0～1,and the differences were statistically significant (q=5.120～12.945,all P<0.05).Spearman correlation analysis,the serum PlGF expression level in diabetes foot patients was negatively correlated with their clinical grading (r=-0.696,P<0.001) and the TREM1 expression level was positively correlated with their clinical grading (r=0.657,P<0.001).Multivariate Logistic regression anaalysis,PlGF was an independent protective factor[OR(95％CI):0.725(0.531～0.990)]and TREM1 was an independent risk factor[OR(95％CI):2.308(1.284～4.147)]affecting the prognosis of diabetic foot patients.The AUC(95％CI) of PlGF,TREM1 levels and their combination to predict the prognosis of diabetes foot patients was 0.898(0.820～0.950),0.817(0.725～0.888)and 0.949 (0.885～0.984),respectively. The clinical efficacy of the combination of the two in predicting the poor prognosis of patients with diabetes foot was better than that of serum PlGF and TREM1 alone (Z=2.150,2.713,P=0.032,0.007). Conclusion The expression of PlGF in serum of patients with diabetes foot is significantly reduced,and the expression of TREM1 is significantly increased. Both of them are closely related to the clinical grading of patients,and they have good clinical efficacy in predicting prognosis.

Objective To explore the serum placental growth factor (PlGF) and triggering receptors expressed on myeloid cell-1 (TREM1)levels in patients with diabetes foot,and the correlation between them and clinical grading and prognosis of patients. Methods From January 2021 to January 2023,97 patients with diabetes foot who were admitted to Affiliated Hospital of Guilin Medical University were collected as the study object (diabetes foot group),and 102 healthy people who were examined in the hospital were collected as the healthy control group. The patients with diabetic foot were categorized into 33 cases of grade 0～1,39 cases of grade 2～3,and 25 cases of grade 4～5 according to Wanger grading criteria. Patients with diabetes foot were followed up for 6 months and divided into good prognosis group (n=72) and poor prognosis group (n=25).Serum PlGF and TREM1 levels were compared between groups. Spearman correlation analysis was applied to explore the correlation between serum PlGF and TREM1 levels and clinical grading in patients,factors influencing the prognosis of patients with diabetic foot was analyzed by Logistic regression . Receiver operating characteristic (ROC) curve was applied to investigate the predictive effect of serum PlGF and TREM1 on the prognosis of patients with diabetes foot. Results The expression level of serum PlGF in the diabetes foot group was lower than that in the healthy control group (53.86±15.13 pg/ml vs 87.57±18.28 pg/ml),and the level of TREM1 was significantly higher than that in the healthy control group (279.56±32.25 ng/L vs 195.37±26.28 ng/L),and the difference was statistically significance (t=14.133,20.232,all P<0.05).Serum PlGF expression (39.41±13.28 pg/ml vs 66.13±16.30 pg/ml,52.75±15.32 pg/ml) was lower in patients with clinical grades 4～5 than in patients with grades 0～1 and 2～3. TREM1 expression (326.66±35.75 ng/L vs 248.21±29.83 ng/L,275.89±32.06 ng/L) was higher than in patients with grades 0～1 and 2～3. Serum PlGF expression was lower in patients with clinical grades 2～3 than in patients with grades 0～1. TREM1 expression was higher than in patients with grades 0～1,and the differences were statistically significant (q=5.120～12.945,all P<0.05).Spearman correlation analysis,the serum PlGF expression level in diabetes foot patients was negatively correlated with their clinical grading (r=-0.696,P<0.001) and the TREM1 expression level was positively correlated with their clinical grading (r=0.657,P<0.001).Multivariate Logistic regression anaalysis,PlGF was an independent protective factor[OR(95％CI):0.725(0.531～0.990)]and TREM1 was an independent risk factor[OR(95％CI):2.308(1.284～4.147)]affecting the prognosis of diabetic foot patients.The AUC(95％CI) of PlGF,TREM1 levels and their combination to predict the prognosis of diabetes foot patients was 0.898(0.820～0.950),0.817(0.725～0.888)and 0.949 (0.885～0.984),respectively. The clinical efficacy of the combination of the two in predicting the poor prognosis of patients with diabetes foot was better than that of serum PlGF and TREM1 alone (Z=2.150,2.713,P=0.032,0.007). Conclusion The expression of PlGF in serum of patients with diabetes foot is significantly reduced,and the expression of TREM1 is significantly increased. Both of them are closely related to the clinical grading of patients,and they have good clinical efficacy in predicting prognosis.

With the rise of digital healthcare in recent years, digital tools, as a new type of health management tool, are expected to become a feasible tool for rehabilitation exercise in stroke patients. The aim of this article is to review the current status of the application of digital tools in self-management of stroke recovery. In addition, the concept, function and application effect of digital tools are introduced, and the existing problems and future research directions are pointed out, in order to provide reference for the self-management of stroke patients in China.

Objective To explore the value of prenatal echocardiography in diagnosis of fetal ventricular septal defect (VSD).Methods Prenatal echocardiography was performed on 3 826 fetuses,and the results were compared with those of postnatal echocardiography or autopsy findings.The diagnostic accuracy,misdiagnosis rate and missed diagnosis rate of prenatal echocardiography for VSD were calculated.Results Among 3 826 fetuses,VSD was found in 61 fetuses (61/3 826,1.59％) with prenatal echocardiography,including simple VSD in 36 fetuses (36/3 826,0.94％) and VSD complicated with other heart malformations in 25 fetuses (25/3 826,0.65 ％).According to the results of autopsy and postnatal echocardiography,the final diagnosis of VSD was found in 76 cases (76/3 826,1.99％),of which simple VSD was found in 51 cases (51/3 826,1.33 ％),VSD complicated with other heart malformations were found in 25 fetuses (25/3 826,0.65％).The diagnostic accuracy,missed diagnosis rate and misdiagnosis rate of simple VSD with prenatal echocardiography was 58.82％ (30/51),41.18％ (21/51) and 1.06‰ (4/3 775),respectively.The diagnostic accuracy,missed diagnosis rate and misdiagnosis rate of VSD complicated with other heart malformations with prenatal echocardiography was 96.00％ (24/25),4.00％ (1/25) and 0.26‰ (1/3 801),respectively.Conclusion Echocardiography has important clinical value in prenatal diagnosis of fetal VSD,which can provide important references for treatment plan and prognosis evaluation.

Objective Metabolites produced by metabolic imbalance such as free fatty acids and lipopolysaccharides can result in a state of chronic low-grade inflammation, or metabolic inflammation, which plays an important role in the pathogenesis of atherosclerosis, type 2 diabetes, non-alcoholic fatty liver disease, and obesity. The above metabolic disorders are closely related with the metabolic inflammation, which always coexist. Therefore, we proposed the concept ofmetabolic inflammatory syndrome ( MIS). According to our study, patients with two or more metabolic disorders above could be diagnosed as MIS. The current research is aimed to investigate the prevalence of MIS and its components, and to compare the clinical values of MIS and metabolic syndrome ( MS) . Methods 2 001 in patients with type 2 diabetes from 6 hospitals in Shanghai were recruited in the current multi-center cross-sectional study. The diagnostic rates of MIS and MS and their components of both syndromes were compared. Results In the patients with type 2 diabetes, the detective rate of MIS was 96. 2%, which was higher than that of MS (71. 3%). Among 4 components of MIS, atherosclerosis showed the highest detective rate (75.6%). MIS[OR=2.252(95%CI1.026-4.942),P=0.043],atherosclerosis[OR=2.726(95% CI1.953-3. 804),P<0. 001], and MS[OR=1. 915 (95%CI 1. 444-2. 540),P<0. 01] were the risk factors of coronary heart disease. Conclusion With atherosclerosis, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and obesity as its 4 components, MIS has a high detective rate in patients with metabolic disorders, and seems to be more sensitive than MS to distinguish inflammation-related metabolic diseases. The concept of MIS will promote the screening and prevention of atherosclerosis in its early stage.

Objective To investigate the influence of acupuncture and stage health education on the function rehabilitation of stroke patients with depression.Methods 85 patients with poststroke depression were divided into a treatment group (44) and a control group (41).All the cases were treated with routine neurological therapy.Based upon it,the treatment group was given acupuncture and stage health education.Barthel (BI) index and movement scale Fugl Meyer (FMA),depression scale Zung (SDS) and Hamilton Depression Scale (HAMD)were observed in the two groups before and after the treatment.Results After eight weeks treatment,the scores of SDS and HAMD in the two groups were (46.97±12.17),(26.04±5.37),compared with the pretreatment scores(56.07± 5.51),(32.74± 5.17),they were significantly reduced.The scores ofBI,FMB were(67.13 ±15.53),(64.41 ±20.03) which were significantly increased (average P＜0.01),this increase was more significant in the treatment group (P＜0.05) Post-stroke depression comparison:the total effect of SDS and HAMD in the treatment group was (77.88％,78.6％),which was more superior to the control group (56.6％,52.4％).Conclusion The acupuncture and stage health education has a significant clinical treatment effect on the patients suffered from post-stroke depression and also can enhance their body movement function as well as the daily ability.

Objective To study the effect of propofol used for outpatient painless enteroscope on cognitive function.Methods One hundred and twenty ASAⅠ~Ⅱpatients scheduled for enteroscope were randomly divided into three groups .Propofol was given 1.5mg/kg(groupⅠ), 2mg /kg (group Ⅱ) or 2.5 mg/kg ( group Ⅲ) intravenously .The enteroscope was inserted when patient showed unconsciousness and no reaction to dictation .SpO2 was kept above 95%96% throughout enteroscope .All patients received neurobehavioral cognitive status examination ( NCSE ) and mini-mental state examination ( MMSE ) test 1 hour before enteroscope examination and 5 minutes,30 minutes, 1 hour after enteroscope examination was o-ver and must finish it within 15 min.The enteroscope examination time , vital signs, analgesia effects and intraoperative awareness were record .Results The ability of memory and calculation at 5 minutes after en-teroscope examination showed a statistical difference between group Ⅰ and ⅡorⅢ( P <0.05),there was no significant difference between in group II and in group Ⅲ( P >0.05 ) , The ability of memory and calcu-lation at 30 minutes, 1 hour after enteroscope examination there was no significant difference in three groups ( P >0.05 ) .In all patients ,the MMSE scores at 5 minutes after enteroscope examination were significant-ly lower than the baseline value ( P <0.05).The MMSE scores at 30 minutes, 1 hour after enteroscope examination in Ⅲgroup patients were significantly lower than the baseline value ( P <0.05 ) .The MMSE scores at 30 minutes, 1 hour after enteroscope examination in I group patients were significantly higher than that inⅡor Ⅲgroup( P <0.05).The MMSE scores at 30 minutes, 1 hour after enteroscope examination there was no significant difference between in group II and in group Ⅲ( P >0.05 ) .The NCSE and MMSE scores at 3hour, 12 hour after enteroscope examination there was no significant difference between in group I and II or Ⅲ( P >0.05).Conclusion Propofol 1.5mg/kg used for painless enteroscope examination has no effect on cognitive function .MMSE and NCSE are suitable for evaluation of outpatient's cognitive func-tion.

OBJECTIVETo study the chemical constituents from Lobelia chinensis.

METHODThe constituents were extracted with 95% EtOH, partitioned with different solvents, and isolated and purified by silica gel column chromatography and crystallization, their structures were elucidated by physico-chemical properties and spectroscopic data.

RESULTSeven compounds were isolated from the titled plant. They were identified as 5-hydroxy-4'-methoxyflavone-7-O-rutinoside (1), n-butyl-O-beta-D-fructopyranoside (2), 5,7-dimethoxycoumarin (3), cirsiumaldehyde (4), diosmetin (5), 5-hydroxymethyl-2-furancarboxaldehyde (6), and 6-hydroxy-7-methoxycoumarin (7).

CONCLUSIONCompounds 2-4, 6, and 7 were obtained from the titled plant for the first time.

Coumarins ; analysis ; Furans ; analysis ; Lobelia ; chemistry ; Plant Extracts ; chemistry ; isolation & purification

OBJECTIVETo identify the optimal dosage of 17beta-estradiol gel + oral progestin for preventing bone loss in postmenopausal Chinese women.

METHODSA 3-year open label, randomized, prospective clinical trial was conducted. Sixty healthy women who had been postmenopausal for 1 to 5 years were recruited and divided into following 4 groups: group 1, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus micronized progesterone (MP) 100 mg/d; group 2, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d; group 3, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus micronized progesterone (MP) 100 mg/d; and group 4, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d. Estrogen and progestin were given continuously for 25 days per month. Bone mineral density (BMD) was measured using quantitative computed tomography (QCT) for trabecular bone of L2-5 and dual energy X-ray absorptiometry (DEXA) for L2-4 and hip 5 times during the trial at baseline and at the 6-, 12-, 18-, 24- and 36-month visits.

RESULTSFifty-nine patients (98.3%, 59/60) stayed in the study for 1 year, 56 patients (93.3%, 56/60) for 2 years, and 51 (85%, 51/50) for 3 years. On average, menopausal symptoms were relieved by 80% after 6 months of treatment. By the 24th month, the mean increase in BMD ranged from 4.3% to 7.5% in trabecular bone; and by the 36th month, it ranged from 4.2% to 6.2% in L2-4 and 1.61% to 3.77% in the neck. There were significant difference after treatment (P < 0.05). Among the four groups, no significant difference (P > 0.05) was found in improvement of symptoms, levels of bone markers or BMD.

CONCLUSIONA daily dose of estradiol gel, either 0.75 mg or 1.5 mg, is effective in preventing early postmenopausal bone loss and relieving menopausal symptoms. After 3-year treatment, spinal BMD could increase steadily, so does hip BMD, especially in the first 2 years.

Administration, Cutaneous ; Adult ; Bone Density ; Estradiol ; administration & dosage ; Estrogen Replacement Therapy ; Female ; Fractures, Bone ; prevention & control ; Humans ; Medroxyprogesterone Acetate ; administration & dosage ; Middle Aged ; Osteoporosis, Postmenopausal ; prevention & control