Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making,and to provide a basis for developing decision support strategies.Methods From April to December 2023,through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing'an District,Shanghai.semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate.Data were analyzed via Braun's style of thematic analysis.Results 4 themes and 10 sub-themes were identified.Theme 1:negative emotional dilemmas(urgent decision-making leads to anxiety,fear,and unknown stroke trajectory increases the sense of uncertainty).Theme 2:supportive environment dilemmas(lack of information support delays decision-making;lack of family support increases decision-making stress;insufficient economic support increases the burden of decision-making).Theme 3:the dilemma of weighing the pros and cons(difficult trade-offs between risk and reward,tough decisions between reality and ethics,conflicting choices of life and dignity).Theme 4:preference management dilemmas(practical difficulties in adhering to patient preferences,impediments to decision-making due to unknown patient preferences).Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas.Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers,as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.

Objective:To explore the journey map of patients with chronic constipation during fecal microbiota transplantation.Methods:This study adopted phenomenological methods. From October to December 2023, purposive sampling was used to select chronic constipation follow-up patients who underwent fecal microbiota transplantation at the Intestinal Microecology Center of Shanghai Tenth People's Hospital as respondents for semi-structured interviews. Colaizzi 7-step analysis method and NVivo 11.0 software were used for data analysis.Results:A total of 15 interviewees were interviewed. During fecal microbiota transplantation, the journey map of constipation patients included stages, mood changes, touchpoints, themes, emotional experiences and opportunities. The patient's experience and needs were summarized into three themes and ten sub-themes, including pre-transplant adaptation disorders to new environments (unfamiliarity and confusion-admission coordination disorders, anxiety and expectations-diverse complex emotions, puzzle and helplessness-asymmetric doctor and patient information), effectiveness-related psychological and social experiences in transplantation (attention and expectations-longing for positive efficacy, perception of benefits and risk avoidance, shame and inferiority-treatment stigmatization experience, questioning and despair-unrealized expectations, treatment resistance-sensitive economic burden), post-transplant transition dilemmas (inaccessible medical services-lack of continuous treatment and nursing, disease recurrence troubles) .Conclusions:This study visualizes the experiences and needs of constipation patients during microbiota transplantation through a patient journey map and identifies multidimensional issues and needs of patients. Clinical medical and nursing staff should pay attention to the needs of patients at different stages of the treatment process when formulating intervention programs to improve the quality of fecal microbiota transplantation nursing.

Objective To explore the predictive value of glucose metabolism and lipid metabolism indexes for in-stent restenosis(ISR)in patients with arteriosclerosis obliterans(ASO)of lower limbs after surgery.Methods A total of 160 patients with ASO of lower limbs admitted to the Second Affiliated Hospital of Zhengzhou University and Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2018 to October 2021 were selected as the research subjects.All patients were treated with percutaneous transluminal angioplasty combined with stent implantation and were followed up for 1 year.Patients were divided into the ISR group(n=59)and the non-ISR group(n=101),according to the incidence of ISR during the follow-up period.General clinical data of patients in the two groups were collected.Univariate analysis was performed to preliminarily screen out the influencing factors for ISR,and the selected indexes were further analyzed by multivariate logistic regression to analyze the influencing factors for the occurrence of ISR in patients with ASO of lower limbs after surgery.The receiver operating characteristic(ROC)curve was used to analyze the value of the glucose metabolism and lipid metabolism indexes one day before discharge alone and their combination in predicting the occurrence of ISR in patients with ASO of lower limbs after surgery.The net benefit rate of predicting the occurrence of ISR in patients with ASO of lower limbs by the levels of glucose metabolism and lipid metabolism indexes one day before discharge alone and their combination was analyzed through the decision curve.Results Among the 160 patients,59 developed ISR,with an incidence rate of 36.88％.There was no significant difference in age,gender,alcohol consumption,complications,affected side,Fontaine stage,fasting plasma glucose,and serum triglycerides of patients between the ISR group and the non-ISR group(P＞0.05);the proportion of smokers and the levels of glycosylated hemoglobin A1c(HbA1c)in peripheral blood and low-density lipoprotein(LDL)in serum of patients in the ISR group were significantly higher than those in the non-ISR group,while the level of high-density lipoprotein(HDL)in serum was significantly lower than that in the non-ISR group(P＜0.05).Multivariate logistic regression analysis showed that the elevated levels of HbA1 c in peripheral blood and LDL in serum were risk factors for ISR in patients with ASO of lower limbs after surgery(odds ratio＞1.00,P＜0.05),and the increased level of HDL in serum was the protective factor for ISR in patients with ASO of limbs after surgery(odds ratio＜1.00,P＜0.05).The ROC curve showed that the area under the curve of peripheral blood HbA1c,serum LDL and HDL levels alone and their combination in predicting the occurrence of ISR in patients with ASO of lower limbs after surgery was 0.717,0.761,0.654,and 0.824,respectively;the specificity was 0.861,0.792,0.851,and 0.663,respectively;and the sensitivity was 0.525,0.678,0.424,and 0.864,respectively.The decision curve showed that the net benefit rate for the combination of peripheral blood HbA1c,serum LDL and HDL levels one day before discharge in predicting the occurrence of ISR in patients with ASO of lower limbs after surgery was higher than that of prediction by the said indexes alone.Conclusion Glucose metabolism index peripheral blood HbA1c and lipid metabolism indexes serum LDL and HDL have certain predictive values for the occurrence of ISR in patients with ASO of lower limbs after surgery,and the net benefit rate of the joint prediction of the three indexes is higher.

Tendons and bones are connected at the tendon-bone interface to transmit force and exchange biological information. However, the formation of fibrous scars after injury to the tendon-bone interface makes it difficult to recover the original structure during surgery and thus reduces its performance. Therefore, the healing of the tendon-bone interface is a hotspot in sports medicine. Numerous studies have already demonstrated that a variety of molecules and cells participate in the tendon-bone interface reconstruction process, and yet the specific mechanism remains unclear. At present, a great number of studies have been carried out on treatment methods, but clinical treatment are varied with no unification. Therefore, the authors review the advances in the biology and mechanics of healing mechanisms of tendon-bone interface as well as the main methods promoting tendon-bone interface healing, so as to provide references and new ideas for further researches on tendon-bone interface healing.

Objective To analyze the return on investment of 3 types of large medical equipments at Pudong's public hospitals in Shanghai.Methods Data on the numbers and purchasing expenditure, annual utilization headcounts, annual income and annual costs of the MRIs, CTs and DSAs were collected from these hospitals, and their breakeven points and recovery period were analyzed in the study. Results At these hospitals, CTs had relatively a higher return on investment in 2016, with 95 000 headcounts per hospital. At the interest rates of 1% , 3% and 5% , nine hospitals could recover their investment, at an average recovery period of 2.88 years, 3.23 years and 3.84 years respectively. That for DSS was poor. Conclusions These hospitals should improve the business performance of these equipments by means of rational purchase, enhanced utilization and sharing mechanism.

Objective To investigate the effect of implanted cortical electrical stimulation (CES) on the expression of Nissl bodies and growth-associated protein 43 (GAP-43) in the brain after ischemic injury,and its mechanism.Methods Models of middle cerebral artery occlusion (MCAO) were established in 23 male Sprague-Dawley rats.They were randomly divided into a CES group (CES,n=13) and a no stimulation group (NS,n=10) and electrical stimulators were implanted in both groups.CES was applied for 14 d in the CES group but not in the NS group.The expression of Nissl bodies and GAP-43 around the infarct were quantified using version 6.0 of the ImagePro Plus system.Results In the CES group the Nissl bodies had a deep color,and their percentage of area was higher than that in the NS group.The GAP-43 positive expression area also had a relatively deep color,and the average percentage of positive expression area was also higher than that in the NS group.Conclusions CES can enhance the expression of Nissl bodies and GAP-43 after cerebral infarction.This suggests that CES can promote axon growth and the formation of new neural circuits.

Objective:To review effects of functional electrical stimulation(FES) on paralyzed or paretic muscles,and introduce the progress of functional electrical stimulation repairing spinal cord injury.Methods:A computer-based search was conducted in CNK/and MEDILINE for articles related to functional electrical stimulation repairing spinal cord injury from November 1990 to November 2009 with the Keywords of spinal cord injury and electrical stimulation.Data were check firstly.Articles related to functional electrical stimulation repairing spinal cord injury were selected and looked for full-texts.The articles were analyzed and summarized.Results:Functional electrical stimulation (FES) can activate paralyzed or paretic muscles to generate functional or therapeutic movements with constant frequency.FES can improve the impaired motor function of muscles stimulated.Functional electrical stimulation technique could repair part of motor function following spinal cord injury.Conclusions:Functional electrical stimulation is a new and promising technique in modem rehabilitation engineering.Functional electrical stimulation (FES) can activate paralyzed or paretic muscles to generate functional or therapeutic movements.FES can improve the impaired motor function of muscles stimulated.

ObjectiveTo investigate the finasteride application during the off-cycle of intermittent androgen blockade (IAB) in patients with advanced prostate cancer treated with IAB.MethodsEighty-seven patients with advanced prostate cancer were divided into two groups: forty-nine patients received IAB (group A), and thirty-eight patients underwent IAB and finasteride during the off-cycle of IAB (group B). The time of treatment cycle and the time to disease progression were compared between the two groups. ResultsThe patients in group A completed 89 treatment cycles and the mean cycle length was (12.8±5.4) months [treatment time and non-treatment time were (6.6±3.5) months and (7.1±4.8) months, respectively]. The patients in group B completed 85 cycles and the mean cycle length was (15.3±5.9) months [treatment time and non-treatment time were (6.9±3.2) months and (9.2v±3.9) months, respectively]. There was a significant difference between group A and B in the mean cycle length and the non-treatment time (P=0.0428,P=0.03).The 3-year progression rate was ( 34.8±3.5 )% in group A and ( 28.4±2.7)% in groups B ( P=0.035). ConclusionsThe application of finasteride during the off-cycle of IAB in patients with advanced prostate cancer treated with intermittent androgen blockade (IAB) can delay progression of advanced prostate cancer.

Objective To discuss the effect of the concentration of dihydrotestostemne(DHT)in prostatic tissue treating by 5a-reductase inhibitors.Methods One hundred and twenty-one pros-tatic samples were selected:group A1(18 patients treating by epristeride for 1 month),group A2(22patients treating by epristeride for 3 months),group B1(23 patients treating by finasteride for 1 month),group B2(21 patients treating by finasteride for 3 months),group C(25 patients non-treating by 5α-reductase inhibitors),group D(12 samples of prostate from body).The concentration of DHT was measured by radio-immunity,Results The concentration of DHT in prostate declined after treating by epristeride 1 month and 3 months(66.21%and 70.60%,P＜0.05).The decline of the concentration of DHT in prostate after treating by epristeride 1 month was larger than 3 months(P＜0.05).The concentration of DHT in prostate declined after treating by finasteride 1 month and 3 months.There Was no signiificant difference of the concentration of DHT in prostate after treating by finasteride 1 month and 3 months.Conclusions The concentration of DHT in prostate can be declined after treating by epristeride and finasteride.The decline of the concentration of DHT is consistent aftertrealring by epristeride.The decline of the concentration of DHT is considerable between epristeride and finasteride.

OBJECTIVETo investigate the therapeutic effect of nerve growth factor (NGF) on changes of myelin basic protein (MBP) and functional repair of sensory and motor nerve following sciatic nerve injury.

METHODSThe sciatic nerves of rats were injured by sectioning with shaver,and divided into 3 groups: NGF group (Group A), group of normal saline solution (Group B), untreated group (Group C). The time point of observation was at the 4th week after operation. Sensory evoked potential (SEP) and motor evoked potential (MEP) were detected by Model WD-4000 nerve potential working diagnosis system. Immunohistochemical analysis was used for identification of MBP.

RESULTSThe latency of SEP in the Group A at the 4th week after operation was shorter than that in the Group B (P<0.05). The MEP was elicited in 76% of the Group A and was higher than that in the Group B. Results of immunohistochemistry showed that there were less MBP-positive cells in the Group A than in the Group B in one and four weeks respectively.

CONCLUSIONSNGF can improve the conductive function of injured peripheral nerve and facilitate regeneration of nerve.

Animals ; Evoked Potentials ; Female ; Immunohistochemistry ; Myelin Basic Protein ; metabolism ; Nerve Growth Factor ; pharmacology ; Peripheral Nerve Injuries ; Peripheral Nerves ; metabolism ; Rats ; Rats, Wistar ; Sciatic Nerve ; injuries ; metabolism