Foot ulcer prevention plays a crucial role in reducing the amputation rate among diabetic patients. With regard to the prevention of diabetic foot ulcers, the 2023 guidelines of the International Working Group of Diabetic Foot(IWGDF) were different from the 2019 counterpart. The most notable change is the addition of high-level evidence to support recommendations, primarily derived from randomized controlled studies. The 2023 guidelines also advocate for local skin temperature measurement, participation in ankle exercise training, and psychological intervention for foot ulcer prevention. This article conducts a comparative analysis of the two guidelines across six key dimensions: identification of high-risk feet, regular examination of high-risk feet, health education, ensuring appropriate daily footwear, addressing ulcer risk factors, and comprehensive foot care. Drawing from clinical insights, the application and prospective implications of the 2023 guidelines in China are also examined.

To analyze the biological characteristics of Pasteurella multocida in bovine respiratory tract and its prevalence in large-scale cattle farms,bacterial isolation,culture,and morphological observation were conducted on the lungs and liver samples of dead cows suffering from respiratory diseases in Hohhot,Inner Mongolia.The isolated strains were studied through biochemical testing,16S rRNA gene sequencing,specific primer PCR identification,capsule serotyping,pathogenicity testing,virulence gene testing,drug sensitivity testing,and drug resistance gene detection methods.The results showed that six strains of Pasteurella multocida serotype A were isolated and identi-fied from the lungs of diseased and dead cows.After sequencing the 16S rRNA sequence of the bac-teria,it was found that the six strains of Pasteurella multocida had the closest genetic relationship with the Chongqing isolate CQ2(CP033599.1).The results of mouse pathogenicity test and viru-lence gene detection showed that all isolates were pathogenic and carried at least 16 or more related virulence genes such as exbB,nanB,sodC,oma 87,etc.,but no hsf1 and toxA were detected.The results of drug sensitivity tests and resistance gene detection showed that the isolated strains were sensitive to different degrees of antibiotics such as ciprofloxacin,ofloxacin,and cefotaxime.They were resistant to streptomycin,clindamycin,and lincomycin,and resistance genes of str A,strB,and tet(H)were detected.The results indicate that there is a certain correlation between the pathoge-nicity and virulence genes,drug resistance phenotype,and drug resistance genes of Pasteurellamultocida type A in cattle.It is recommended to use quinolones(such as ciprofloxacin)and cepha-losporins(such as cefotaxime)antibacterial drugs in clinical practice,which can provide scientific basis and prevention and control plans for the prevention and treatment of respiratory diseases caused by Pasteurella multocida in cattle farms,and lay a foundation for the epidemiological mo-nitoring of bovine respiratory multocida pasteurellosis.

Objective:To translate the University of Rhode Island Change Assessment of voice scale（URICA-Voice） into Chinese and test its reliability and validity. Methods:The URICA-Voice scale was converted into Chinese by literal translation, cultural adjustment, expert consultation, pre-investigation, and back translation. Convenience sampling was used to recruit patients at four speech therapy centers from February to May 2022. Then the Chinese version of the scale was distributed to them, and the reliability and validity of the scale were tested after data collection. Cronbach ɑ was used to evaluate the reliability. The critical ratio method and Pearson correlation coefficient were used for item analysis. Item-level content validity, scale-level content validity, and confirmatory factor analysis were used to test the validity of the scale. Results:A total of 247 valid questionnaires were collected. ①Item analysis: the critical ratios between a high-score and low-score groups of 32 items were all statistically significant（P<0.01） and all the critical ratios were above 3.00. The Pearson correlation between 32 items and the total score was significant（P<0.01）. ②Validity analysis: I-CVI=1.00, S-CVI/Ave=1.00, χ²/df=2.30, RMSEA=0.07. Except for item 9 and 23, the standardized factor loading coefficients of other items were all above 0.50. AVE of the four dimensions of the scale was all above 0.50, and the combined reliability of the four dimensions was all above 0.70. The correlation coefficients between dimensions were less than the square root of the AVE of the dimension itself. ③Reliability analysis: the Cronbach ɑ of the whole scale was 0.94, and the Cronbach ɑ of the four dimensions were 0.88, 0.92, 0.94, and 0.88 respectively. Conclusion:The Chinese version of URICA-Voice has good reliability and validity, and can be used as a specific measurement tool for evaluating the compliance of voice training in China.
Humans ; China ; Language ; Reproducibility of Results ; Surveys and Questionnaires ; Voice

Objective: To explore the promotion effect of laparoscopic standardized surgery for gastric cancer observational in some regional medical centers in Shanghai. Methods: A retrospective cohort study was carried out. Eleven regional medical centers in Shanghai received the promotion program of laparoscopic standardized surgery for gastric cancer, which was led by Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Shanghai Minimally Invasive Surgery Center) from January to December 2020. Clinicopathological data of gastric cancer patients treated at these 11 regional medical centers before and after the promotion program were collected. Inclusion criteria were as follows: patients undergoing laparoscopic distal gastrectomy or total gastrectomy; gastric cancer confirmed by pathology; without distant metastasis or peritoneal metastasis. Patients who did not undergo laparoscopic D2 radical resection, or received neoadjuvant chemotherapy before surgery, or without complete clinical data were excluded. Patients undergoing laparoscopic surgery from January to December 2019 were included in the pre-promotion group (46 cases). Patients undergoing laparoscopic surgery from January to December 2021 were included in the post-promotion group (102 cases). In addition, patients undergoing laparoscopic surgery at Ruijin Hospital from January 2021 to December were included in the control group (138 cases). The baseline data, perioperative measurements postoperative complications, and pathological results of the three groups were analyzed and compared. Results: There were no significant differences in baseline characteristics among the three groups (all P>0.05). Compared with the pre-promotion group, the operation time in post-promotion group was significantly shorter [(207.3±36.0) minutes vs. (254.2±47.1) minutes, t=7.038,P<0.001], and the number of harvested lymph node was significantly more (24.4±12.2 vs. 18.9±5.5, t=2.900, P=0.004). However, there were no significant differences in the extent of resection, time to fluid intake, and postoperative hospital stay between the two groups (all P>0.05). Compared with the control group, the operation time [(207.3±36.0) minutes vs (172.6±26.0) minutes, t=8.281, P<0.001], time to fluid intake [(6.3±3.2) days than (5.5±3.0) days, t=2.029, P=0.044], and the postoperative hospital stay [(14.3±5.6) days vs. (10.1±4.8) days, t=6.036, P<0.001] in the post- promotion group were still longer. Total gastrectomy was less common in the post-promotion group compared with the control group [18 cases (17.6%) vs. 41 cases (29.7%), χ²=7.380, P=0.007]. However, there was no significant difference in the number of harvested lymph node between the two groups (P>0.05). The morbidity of postoperative complication in the post-promotion group (9.8%, 10/102) was significantly lower than that in the pre-promotion group (23.9%, 11/46) (χ²=5.183, P=0.023), while above morbidity was not significantly different between the post-promotion group and the control group [9.8% vs. 6.5% (9/138), χ²=0.867, P=0.352]. Conclusion: After the promotion of laparoscopic standardized surgery for gastric cancer in regional medical centers, the standardization degree of surgery has been improved, and the morbidity of postoperative complication decreases. Laparoscopic standardized surgery for gastric cancer can be promoted to more regional medical centers.
China ; Gastrectomy/methods* ; Hospitals ; Humans ; Laparoscopy ; Lymph Node Excision/methods* ; Postoperative Complications/etiology* ; Retrospective Studies ; Stomach Neoplasms/pathology* ; Treatment Outcome

ObjectiveTo understand the current situation and influencing factors of health service demands of new residents in Shanghai. MethodsFrom July to August 2020， a questionnaire survey was conducted in 1 358 new residents from 36 survey points in 7 districts of the city. The questionnaire included the basic medical insurance coverage in the inflow area， the current situation of medical demand and related influencing factors， and the demands for other health services. Results47.1%（562/1 194）of new residents did not choose to seek timely medical treatment when they were not feeling well. The main reason was that the working hours occupied the medical treatment time. Logistic regression analysis showed that the main factors affecting the medical needs in new residents were the average daily working hours， living area and type of residence， health status， physical examination and physical exercise， and the type of basic medical insurance. The demands of new residents for "health consultation of common diseases and frequently occurring diseases"， "health behavior intervention （such as smoking cessation and alcohol restriction）"， "medical guidance and publicity"， "accidental injury prevention （traffic， work， falling， etc.）" and "maintenance of legitimate rights and interests of health" were 57.1%（682/1 194）、41.3%（493/1 194）、34.9%（417/1 194）、32.2%（385/1 194） and 31.9%（381/1 194）， respectively. ConclusionNew residents demands for medical services cannot be met. We should actively improve the working and living conditions of new residents， improve the construction of new residents' health service system， and improve the utilization level of health services.

Air Pollution ; Asthma/drug therapy* ; China ; Humans ; Treatment Adherence and Compliance

The prevalence of lower digestive tract diseases is high. White light endoscopy, narrow-band imaging (NBI) and blue laser imaging (BLI) are commonly used in the diagnosis of lower digestive tract diseases, but they have some limitation in the detection of small and atypical lesions. In recent years, linked color imaging (LCI), as a unique image-enhanced endoscopic technique, has shown its unique advantages in the detection of lower digestive tract diseases, the judgment of pathological classification of colorectal polyps, and the assisted endoscopic treatment of intestinal lesions. This article reviewed the research progress of LCI in endoscopic diagnosis of lower digestive tract diseases.

Upper digestive tract diseases include Barrett's esophagus, esophageal squamous cell carcinoma, Helicobacter pylori infection, gastric cancer, etc. Although white light imaging, blue laser imaging and narrow-band imaging have a certain ability to identify these upper digestive tract lesions, however, there are still some missed diagnosis and misdiagnosis of early lesions. Linked color imaging (LCI) could improve the diagnostic accuracy and sensitivity of upper digestive tract lesions through the unique color enhancement technology of endoscopic images. This article reviewed the research progress of LCI in endoscopic diagnosis of upper digestive tract lesions.

Objective:To investigate the efficacy and clinical experiences of fluorescein angiography assisted occlusion via lateral-orbital keyhole approach in internal carotid bifurcation aneurysms. Methods:The clinical data of 16 patients with internal carotid artery bifurcation aneurysms admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients accepted fluorescein angiography assisted occlusion via lateral-orbital keyhole approach. The patients were followed up at one, 3, and 6 months after surgery by medical imaging. The therapeutic efficacy of these patients was assessed by Glasgow outcome scale (GOS). Results:All aneurysms in these 16 patients were clipped at one-stage operation. Intraoperative fluorescein angiography and FLOW 800 showed that the aneurysms were completely clipped without residual, and the blood flow of the parent artery and perforating arteries was unobstructed. Six months after surgery, 14 patients recovered well (GOS scores of 5), and 3 developed limb hemiplegia (GOS scores of 4).Conclusion:Intraoperative fluorescein angiography assisted occlusion via lateral-orbital keyhole approach is safe and effective in internal carotid bifurcation aneurysms.

Objective To investigate the prevalence and epidemiological characteristics of enuresis in children aged 5-13 years old in Jinshan District, Shanghai, and analyze the relevant pathogenic factors, so as to provide a reference for clinical prevention and treatment of enuresis in children and related psychological diseases. Methods Using the medical history collection table (CMT checklist) of ICCS (International Association for Urinary Control of Children) as a guidance, a random cluster sampling was performed on 1 000 preschool and school-age children from 9 representative schools with a relatively concentrated population in Jinshan District. Results Excluding the missing and invalid questionnaires, a total of 785 cases were included in the study, and the total prevalence of enulists in 5-13 children was 7.77% (61 cases), among which 42 cases were 5-7 years old (68.85%), 12 cases were 8-10 years old (19.67%), and 7 cases were 11-13 years old (11.48%). There were statistically significant differences among the age groups (χ²=52.87，P=0.001)). Among the affected children, 3.31% (26 cases) were in urban areas and 4.46% (35 cases) in rural areas (P<0.05). The prevalence of boys (38 cases) and the prevalence of girls (23 cases) were statistically significant (P<0.05). The characteristics of enuresis, organic diseases, and attention were analyzed in 61 children diagnosed with enuresis. Children with enuresis ≥7 times/week were the highest (33 cases), accounting for 54.10%; children with 3-6times/week (19 cases) accounted for 31.15%; 2 times/week (9 cases) accounted for 14.75%. Physical examination abnormalities (including urinary routine abnormalities: urinary tract infection, hematuria, high urinary calcium or phimosis) were found in 18 cases, accounting for 29.51%. Four patients (6.56%) had a family history of enuresis. Fifty-two (85.25%) of the affected children had psychologically related problems: introverted personality, impulsiveness, inferiority, lack of concentration, medium or inferior academic performance. Conclusion The prevalence of enuresis in 5-13 children was 7.77%. There were significant differences between urban and rural areas, different age groups and genders as well. Most sick children developed organic diseases and some degree of psychological problems. A timely diagnosis and treatment of enuresis in children in combination with psychological guidance and behavioral intervention is necessary for the prevention of the occurrence of enuresis related psychological problems.