Objective To establish a phase Ⅱ remote home-based cardiac rehabilitation (HBCR) program for patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) based on social cognitive theory (SCT). Methods A preliminary draft of the phase Ⅱ HBCR program for CHD patients after PCI based on SCT was developed through evidence-based literature review and group discussion, and the final version was formed through Delphi expert consultation. Results A total of 18 experts participated in three rounds of expert consultation. The expert authority coefficients for the three rounds were 0.86, 0.87 and 0.87 respectively, and the Kendall's W coefficients were 0.211, 0.242 and 0.271 respectively, with significant differences (P < 0.01). The final phase Ⅱ HBCR program for CHD patients after PCI included four primary items: comprehensive assessment, correction of rehabilitation cognition, improvement of social support, and implementation pathway, with 10 secondary items and 27 tertiary items. Conclusion Phase Ⅱ remote HBCR program for CHD patients after PCI constructed in this study is scientific and reliable, and may provide guidance for HBCR nursing.

Objective To investigate the therapeutic effect of three-line anchors combined with modified Mason-Allen technique in repair of moderate to massive rotator cuff tear under arthroscopy. Methods The clinical data of 48 patients (repair of moderate to massive rotator cuff tear using modified Mason-Allen technique) were analyzed retrospectively. According to the anchors used, patients were divided into control group (double-wire anchors, n=23) and observation group (three-wire anchors, n=25). Age, gender, operation time, the number of anchors used during operation and postoperative complications were recorded in the two groups. American shoulder and elbow surgeon (ASES) scores, Constant-Murley shoulder function scores and Visual Analogue Scale (VAS) scores were compared between the two groups before and after surgery (last follow-up). During follow-up, magnetic resonance imaging(MRI)was used to evaluate rotator cuff retear. Results At the last follow-up, VAS score of the shoulder in the two groups was significantly lower than before surgery, constant-Murley shoulder function score and ASES score were significantly higher than before surgery (P < 0.05). The number of anchors used in the control group was significantly higher than that in the observation group (P < 0.05). Conclusion The clinical effect of three-line anchor combined with the modified Mason-Allen technique in repair of moderate to massive rotator cuff tear is better, which is consistent with the traditional two-wire anchors, but the amount of anchors is less.

Objective:To survey on the status quo of the management capabilities of general practice team leaders in community health service centers in Shanghai.Methods:Using stratified sampling method, 18 community health service centers in the urban and suburban areas of Shanghai were selected, then the general practice team leaders and general practitioners (team members) in the centers were selected as the study participants. The questionnaire survey on the management capabilities of general practice team leaders was conducted among selected participants from November to December 2021. The self-assessment by general team leaders and the other-assessment by team members were carried out, and the total scores was calculated according to the weight of self-evaluation score (30%) and other-evaluation score(70%).Results:A total of 110 general practice team leaders and 749 team members participated in the survey. Among the team leaders, 63.64% (70/110) were females, 82.73% (91/110) were bachelor degree holders, 71.82% (79/110) had intermediate professional title, and 50.91% (56/110) worked for more than 9 h per day. The total score of general practice team leaders was (87.15±10.76) points, the other-assessment score was significantly higher than self-assessment score ((88.62±9.34) vs.(83.71±14.08), t=2.22, P<0.05). The average score of the 5 dimensions was 4.41 for special business management, 4.39 for organizational management, 4.38 for personal quality, 4.27 for teaching and research management and 4.22 for strategy and cultural construction, respectively. Conclusion:The overall management capabilities of Shanghai community general practice team leaders are at the upper-middle level, however, the capabilities in scientific research and team planning are relatively weak.

Objective:To analyze the relationship between capacity of general practice team leaders and the team performance in community health service centers.Methods:This study was a cross-sectional study. A questionnaire survey was conducted between November and December 2022, among general practice team leaders and general practitioners (GPs) from 18 community health service centers in the urban and suburban areas of shanghai selected by stratified sampling method. The personal information questionnaire, leadership of general practice team leader questionnaire,and work performance scale of general team members were used for the survey. The relationship between leadership of general practice team leaders and team performance was analyzed based on structural equation model (SEM).Results:A total of 944 questionnaires were distributed and 856 valid ones were returned with a response rate of 91.0%, including 110 general practice team leaders and 749 were GPs. The SEM analysis showed that some dimensions of the management ability of the general practice team leader had significant effect on the employee organization loyalty (organizational management: β=0.37, teaching and research management: β=-0.29, strategy and cultural construction: β=0.23, personal quality: β=0.11) and work performance (special business management: β=0.95, organizational management: β=0.54) (all P<0.05); and employee organization loyalty played a partial mediator role in relationship between leadership of general practice team leaders and work performance with a mediating effect of 39.50%. Conclusion:The management ability of the general practice team leader directly affect or indirectly affect the work performance of team members through team members′ organizational loyalty.

Objective    To provide experimental data and theoretical support for further studying the maturity of cardiac patches in other in vitro experiments and the safety in other in vivo animal experiments, through standard chemically defined and small molecule-based induction protocol (CDM3) for promoting the differentiation of human induced pluripotent stem cells (hiPSCs) into myocardium, and preliminarily preparing cardiac patches. Methods    After resuscitation, culture and identification of hiPSCs, they were inoculated on the matrigel-coated polycaprolactone (PCL). After 24 hours, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and the stemness of hiPSCs was identified by OCT4 fluorescence. After fixation, electron microscope scanning was performed to observe the cell morphology on the surface of the patch. On the 1st, 3rd, 5th, and 7th days of culture, the cell viability was determined by CCK-8 method, and the growth curve was drawn to observe the cell growth and proliferation. After co-cultured with matrigel-coated PCL for 24 hours, hiPSCs were divided into a control group and a CDM3 group, and continued to culture for 6 days. On the 8th day, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and hiPSCs stemness was identified by OCT4 fluorescence, and cTnT and α-actin for cardiomyocyte marker identification. Results    Immunofluorescence of hiPSCs co-cultured with matrigel-coated PCL for 24 hours showed that OCT4 emitted green fluorescence, and hiPSCs remained stemness on matrigel-coated PCL scaffolds. DAPI emitted blue fluorescence: cells grew clonally with uniform cell morphology. Scanning electron microscope showed that hiPSCs adhered and grew on matrigel-coated PCL, the cell outline was clearly visible, and the morphology was normal. The cell viability assay by CCK-8 method showed that hiPSCs proliferated and grew on PCL scaffolds coated with matrigel. After 6 days of culture in the control group and the CDM3 group, immunofluorescence showed that the hiPSCs in the control group highly expressed the stem cell stemness marker OCT4, but did not express the cardiac markers cTnT and α-actin. The CDM3 group obviously expressed the cardiac markers cTnT and α-actin, but did not express the stem cell stemness marker OCT4. Conclusion    hiPSCs can proliferate and grow on matrigel-coated PCL. Under the influence of CDM3, hiPSCs can be differentiated into cardiomyocyte-like cells, and the preliminary preparation of cardiac patch can provide a better treatment method for further clinical treatment of cardiac infarction.

Objective:To detect the expression of interleukin 2 (IL-2)/Janus kinase 3/signal transduction and transcriptional activator 5 (JAK3/STAT5) signaling pathway in peripheral blood of patients with ankylosing spondylitis (AS) and explore its mechanism in the development and progression of AS.Methods:Clinical data, peripheral blood and laboratory tests of 30 patients with active AS (ASA), 30 patients with stable AS (ASS) and 50 healthy subjects (HC) were collected. The mRNA expression levels of JAK3, signal transduction and transcription activator 5a (STAT5a) and signal transduction and transcription activator 5b (STAT5b) were detected by quantitative real-time-polymerase chain reaction (RT-qPCR). The expression levels of JAK3, STAT5a and STAT5b proteins and phosphorylated proteins were detected by Western-blot. Plasma IL-2 concentration was determined by enzyme-linked immunosorbent assay (ELISA). Two independent samples t-test or one-way analysis of variance were used for measurement data consistent with normal distribution, LSD- t test was used for pairwise comparison between the three groups, Mann-Whitney U test or Kruskal-Wallis H test was used for non-normal distribution, χ2 test was used for correlation analysis of categorical variables. Spearman correlation analysis was used for correlation analysis between variables, and receiver operating characteristic (ROC) curve was used to evaluate the value of JAK3, STAT5a and STAT5b mRNA expression levels in monitoring AS activity. Results:① The mRNA expression levels of JAK3, STAT5a and STAT5b were significantly different among the three groups ( F=65.98, P<0.001; F=21.15, P<0.001; F=13.67, P<0.001). JAK3 mRNA expression in ASA group (2.5±0.9) was significantly higher than that in ASS group (1.1±0.4) and healthy subjects (1.0±0.5), the difference was statistically significant (both P<0.001). The mRNA expression level of STAT5a in ASA group (1.4±0.3) was significantly higher than that in ASS group (0.9±0.3) and healthy subjects group (1.0±0.3), the difference was statistically significant (both P<0.001). STAT5b mRNA expression level in ASA group (1.5±0.6) was significantly higher than that in ASS group (1.0±0.4) and healthy subjects (1.0±0.4), the difference was statistically significant (both P<0.001). The expression level of JAK3 mRNA in HLA-B27 positive group (1.9±1.0) was higher than that in HLA-B27 negative group (1.4±0.6), and the difference was statistically significant ( t=-2.22, P=0.032). The phosphorylation levels of JAK3, STAT5a and STAT5b showed statistically significant differences among the three groups ( F=91.56, P<0.001; F=25.15, P< 0.001; F=178.59, P<0.001). The phosphorylation level of JAK3 protein in ASA group (1.04±0.08) was significantly higher than that in ASS group (0.568±0.019) and healthy subjects (0.536±0.064), the difference was statistically significant (both P<0.001). The phosphorylation level of STAT5a protein in ASA group (1.166±0.096) was significantly higher than that in ASS group (0.923±0.018) and healthy subjects (0.911±0.017), the difference was statistically significant (both P<0.001). The phosphorylation level of STAT5b protein in ASA group (0.81±0.05) was significantly higher than that in ASS group (0.21±0.03) and healthy subjects (0.24± 0.07), the difference was statistically significant (both P<0.001). The difference of plasma IL-2 concentration among the three groups was statistically significant ( F=3.32, P=0.040). The IL-2 concentration in the ASA group [(110±40) pg/ml] was significantly higher than that in the ASS group [(89±40) pg/ml] and the healthy group [(88±39) pg/ml], the difference was statistically significant ( P=0.044, P=0.016). ② Spearman correlation analysis showed that STAT5a mRNA expression level was positively correlated with platelets in AS patients ( r=0.353, P=0.006). JAK3 mRNA expression level in ASA group was positively correlated with IL-2 concentration ( r=0.766, P<0.001), and negatively correlated with estimated glomerular filtration rate ( r=-0.485, P=0.007). STAT5a mRNA expression level was positively correlated with erythrocyte sedimentation rate ( r= 0.680, P<0.001), and STAT5b mRNA expression level was positively correlated with hypersensitive C-reactive protein (CRP) ( r=0.823, P<0.001). ③ The ROC curve showed that JAK3 mRNA expression level predicted the area under ROC curve (AUC) of ASA with a 95% CI of 0.920 (0.853, 0.987), sensitivity and specificity of 86.7% and 90.0%, respectively. STAT5a mRNA expression level predicted the AUC 95% CI of ASA was 0.874 (0.787, 0.961), and the sensitivity and specificity were 96.7% and 66.7%, respectively. STAT5b mRNA expression level predicted the AUC 95% CI of ASA was 0.749 (0.617, 0.881), and the sensitivity and specificity were 73.3% and 80.0%, respectively. Conclusion:This study suggests that IL-2/JAK3/STAT5 may be involved in the pathogenesis of AS, and JAK3 mRNA can be used as a biological indicator to monitor the activity of AS disease.

OBJECTIVES: To summarize our experience with the sural neurofasciocutaneous flap for reconstructing the soft tissue defects over the forefoot distal to the connecting line of midpoints in the metatarsal bones, and to compare the outcomes between the flap for resurfacing the defects distal and proximal to the connecting line. METHODS: The clinical data of 425 sural neurofasciocutaneous flaps for repairing the soft tissue defects in the middle and lower leg, ankle, and foot between Apr. 2002 and Apr. 2020 were reviewed. Based on the connecting line of midpoints of the metatarsals, the sural neurofasciocutaneous flaps were divided into a forefoot group (flaps with furthest edges distal to the connecting line) and a peri-ankle group (flaps with the furthest edges proximal to the connecting line). RESULTS: The partial necrosis rate in the forefoot group (14.5%, 10/69) was significantly higher than that in the peri-ankle group (7.0%, 25/356), with significant difference (P<0.05). Using the flap alone or in combination with a simple salvage treatment, the ratio of successful coverages of the defects was 98.6% (68/69) in the forefoot group, and 97.8% (348/356) in the peri-ankle group, respectively, with no statistical difference (P>0.05). CONCLUSIONS The sural neurofasciocutaneous flap is a better choice for covering the soft tissue defects over the forefoot distal to the connecting line of midpoints of the metatarsal bones. The survival reliability of the sural neurofasciocutaneous flap reconstructing the soft tissue defect proximal to the connecting line is superior to that of the flap reconstructing the defect distal to the connecting line.
Ankle/surgery* ; Humans ; Reconstructive Surgical Procedures ; Reproducibility of Results ; Soft Tissue Injuries/surgery* ; Surgical Flaps

Objective:The arsenic content of drinking water in Aksu Prefecture of Xinjiang Uygur Autonomous Region (referred to as Xinjiang) was analyzed to understand the distribution of arsenic content and arsenic form of water in each county and city.Methods:In 2020, a total of 117 waterworks and villages (towns) under the jurisdiction of waterworks in 7 counties and 2 cities were randomly sampled, arsenic content in water was detected by atomic fluorescence spectrometry, and arsenic form in water was detected by liquid chromatography atomic fluorescence spectrometry.Results:A total of 626 water samples were collected, 614 water samples with water arsenic content < 0.01 mg/L, accounting for 98.08%; 12 water samples with water arsenic content 0.01 - < 0.05 mg/L, accounting for 1.92%; and there was no water sample with arsenic content ≥0.05 mg/L. The form of arsenic in excessive water sample in Aksu Prefecture was found to be five-valent arsenate. The arsenic content in the water of Awati County was the highest (0.004 6 mg/L).Conclusions:There are still some counties and cities with high arsenic content in water in Aksu Prefecture, and there are still hidden dangers of drinking-water brone endemic arsenism. Therefore, the water treatment technology should be improved or the water sources should be changed to prevent endemic arsenism.

Objective:To develop an evaluation index system for the management ability of general practice team leaders in community health service centers.Methods:Based on literature review, key insider interviews and other methods, the framework and indicator pool for management capability of general practice team leaders were formed. Two rounds of Delphi consultations with 15 experts were conducted from July to October 2021, and the evaluation index system of general practice team leaders' management ability established.Results:All 15 experts had at least 5 years of work experience, including 10 engaging in clinical general practice, 3 in public health and 2 in community management. The response rates for the two rounds of expert consultation was 15/15, and the expert authority coefficient was 0.84, with Kendall's W coefficient of 0.35 ( P<0.001) and 0.46 ( P<0.001), respectively. Finally, the evaluation index system of the management ability of general practice team leaders was established, which consisted of 5 primary indicators (personal quality, special business management, organizational management, teaching and research management, strategy and culture building), 11 secondary indicators and 37 tertiary indicators. Conclusions:The management capability evaluation index system general practitioner team leaders of the community health centers has been established in this stu, which may be used for the training and selection of general practice team leaders in the community health centers.

Background::Single-tablet regimen (STR) provides a convenient once-daily regimen for the prevention of human immunodeficiency virus (HIV) infection. Here, we investigated the safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a three-drug, STR for post-exposure prophylaxis (PEP) in Chinese individuals.Methods::This was a prospective, open-label, single-arm trial conducted in a sexually transmitted diseases and acquired immunodeficiency syndrome clinic of a tertiary hospital in Beijing, China. Adults requiring PEP were prescribed BIC/FTC/TAF one pill once a day for 28 days. Clinical and laboratory data were collected and analyzed at baseline, weeks 2, 4, 8, 12, and 24.Results::Of 112 participants enrolled in the study, 109 (97.3%) were male and the mean age was 30 ± 8 years. PEP completion was 96.4% (95% confidence interval: 91.1-99.0%). Two participants stopped PEP after 2 days because the source partner was identified as HIV uninfected. One participant was excluded due to hepatitis B virus infection according to the exclusion criteria. One discontinued due to the participant’s decision. No participant acquired HIV through week 24. Adherence was 98.9% (standard deviation [SD]: 3.3%) by self-reporting and 98.5% (SD: 3.5%) by pill count. Only five participants experienced mild clinical adverse events attributed to the study drug (including headache, diarrhea, and nausea) and four participants had elevated serum creatinine (grade 1).Conclusions::A once daily, STR of BIC/FTC/TAF used as PEP was safe and well-tolerated with a high rate of completion and adherence in Chinese. BIC/FTC/TAF may be a good option for PEP.Trial Registration::ChiCTR.org.cn, ChiCTR2100048080