Objective:To construct an early rehabilitation management model for postoperative kinesiophobia patients after total knee arthroplasty (TKA) based on a topic-oriented quality control circle method, aiming to improve the quality of early rehabilitation management.Methods:Using a convenience sampling method, 120 TKA patients with kinesiophobia treated in the Department of Orthopedics at the First Affiliated Hospital of Zhengzhou University from January to April 2022 and September to December 2022 were selected. The patients from January to April 2022 were set as the control group, and those from September to December 2022 were set as the observation group, with 60 patients in each group. The control group received routine rehabilitation management after TKA surgery, while the observation group received the early rehabilitation management model based on the 10 steps of the topic-oriented quality control circle (topic selection, activity planning, clarification of the topic, goal setting, countermeasure formulation, pursuit of optimal strategies, etc.) in addition to the routine management. The differences between the two groups were compared in terms of kinesiophobia score, knee function score, pain score, early rehabilitation assessment rate, effective analgesia rate, and 24-hour ambulation rate.Results:After the intervention, the observation group showed significantly lower knee pain scores (2.89±0.66) and kinesiophobia scores (23.27±4.87) compared to the control group, with a significantly higher knee function score (74.47±7.40), all differences were statistically significant (all P<0.01). Additionally, the observation group had a significantly higher early rehabilitation assessment rate, effective analgesia rate, 24-hour ambulation rate, early rehabilitation compliance rate, earlier time for the first ambulation, shorter hospital stay, and reduced costs compared to the control group, with all differences showing statistical significance (all P<0.01) . Conclusions:The application of the topic-oriented quality control circle to construct and implement an early rehabilitation management model for postoperative kinesiophobia patients after TKA can effectively improve the quality of early rehabilitation management, reduce kinesiophobia levels, enhance knee joint function, and alleviate the economic burden.

Objective:To construct an early rehabilitation management model for postoperative kinesiophobia patients after total knee arthroplasty (TKA) based on a topic-oriented quality control circle method, aiming to improve the quality of early rehabilitation management.Methods:Using a convenience sampling method, 120 TKA patients with kinesiophobia treated in the Department of Orthopedics at the First Affiliated Hospital of Zhengzhou University from January to April 2022 and September to December 2022 were selected. The patients from January to April 2022 were set as the control group, and those from September to December 2022 were set as the observation group, with 60 patients in each group. The control group received routine rehabilitation management after TKA surgery, while the observation group received the early rehabilitation management model based on the 10 steps of the topic-oriented quality control circle (topic selection, activity planning, clarification of the topic, goal setting, countermeasure formulation, pursuit of optimal strategies, etc.) in addition to the routine management. The differences between the two groups were compared in terms of kinesiophobia score, knee function score, pain score, early rehabilitation assessment rate, effective analgesia rate, and 24-hour ambulation rate.Results:After the intervention, the observation group showed significantly lower knee pain scores (2.89±0.66) and kinesiophobia scores (23.27±4.87) compared to the control group, with a significantly higher knee function score (74.47±7.40), all differences were statistically significant (all P<0.01). Additionally, the observation group had a significantly higher early rehabilitation assessment rate, effective analgesia rate, 24-hour ambulation rate, early rehabilitation compliance rate, earlier time for the first ambulation, shorter hospital stay, and reduced costs compared to the control group, with all differences showing statistical significance (all P<0.01) . Conclusions:The application of the topic-oriented quality control circle to construct and implement an early rehabilitation management model for postoperative kinesiophobia patients after TKA can effectively improve the quality of early rehabilitation management, reduce kinesiophobia levels, enhance knee joint function, and alleviate the economic burden.

Objective:To investigate the prevalence and risk factors of hypertensive retinopathy (HRP) in a non-diabetic population over 30 years old during routine health examinations.Methods:This was a cross-sectional study of a non-diabetic population over 30 years of age. The study was conducted during routine health examinations at the Tongren Hospital, Beijing, from January to December 2020. Fundus photographs were taken, and data including medical history, height, weight, and blood pressure were collected. Routine laboratory examinations were performed. The study population was divided into hypertension, transient hypertension, and non-hypertension groups. The prevalence of HRP was compared among the three groups. OR and 95% CI of HRP risk factors was estimated by binary logistic regression, adjusted for age and gender. Results:The prevalence of HRP was 4.3% in the non-diabetic population over 30 years old. Adjusted for age, gender, and systolic blood pressure, the prevalence of HRP in hypertension and transient hypertension groups, was both higher than in the non-hypertension group [ OR(95% CI) of 3.11(2.25-4.30) and 1.72(1.21-2.45), respectively]. The proportion of grade 1-2 HRP was higher (76.2%). There was no significant difference in the prevalence of grade 3 HRP among the three groups. Adjusted for age and gender, systolic blood pressure and creatinine clearance rate were independent risk factors for HRP in the hypertension group [ OR(95% CI): 1.22(1.01-1.48) and 1.66(1.12-2.46)] and transient hypertension group [ OR(95% CI): 1.48(1.10-2.06) and 1.95(1.03-3.46)]. SBP and DBP were independent risk factors for HRP in the non-hypertension group [ OR(95% CI): 1.68(1.07-2.63) and 1.61(1.06-2.44)]. Conclusions:There was a high prevalence of HRP among the non-diabetic population over the age of 30 and there was still relatively high risk of grade 3 HRP among the normotensive population.

Objective:To investigate the effect of drug metabolism related gene polymorphism on the efficacy of clopidogrel in patients with acute coronary syndrome (ACS).Methods:The medical records and follow-up records of ACS patients, who were hospitalized in the People′s Hospital of Daxing District between 2017 and 2019, received standardized treatment with aspirin (100 mg/day)+clopidogrel (75 mg/day), and underwent testing for genetic polymorphisms related to clopidogrel absorption/metabolism, were collected. The patients were divided into thrombotic event group and non-thrombotic event group according to whether they experienced thrombotic events such as myocardial infarction, stent thrombosis, and cerebral infarction within 1 year of treatment. The age, gender, smoking history and drinking habits, underlying diseases, drug combination, and alleles related to clopidogrel absorption/metabolism in patients in the 2 groups were compared. The factors affecting the clinical efficacy of clopidogrel was analyzed using logistic regression model.Results:A total of 342 patients were included in the analysis, including 274 males and 68 females, aged (58±9) years; of them, 78 (22.8%) developed thrombotic events. The differences in age, gender, smoking history, drinking history, hypertension, diabetes mellitus, hyperlipidemia, percutaneous coronary intervention history, proportion of combined with calcium channel antagonists, cytochrome P450 (CYP) 2C19*3, paraoxonase-1 Q192R, and adenosine triphosphate binding cassette transporter B1 C3435T between the thrombotic event group and the non-thrombotic event group were not statistically significant (all P>0.05), but the body mass index (BMI), the proportion of CYP2C19*2 GG type and CYP2C19*17 CT type in patients in the thrombotic event group were lower than those in the non-thrombotic event group (all P<0.05), and the proportion of patients with proton pump inhibitor and CYP2C19*17 CC type in the thrombotic event group was higher than that in the non-thrombotic event group (all P<0.05). Multivariate logistic regression analysis showed that high BMI ( OR=0.915, 95 %CI: 0.847-0.989, P=0.026), CYP2C19*2 GG type ( OR=0, 95 %CI: 0-0.008, P<0.001), and GA type ( OR=0.028, 95 %CI: 0.003-0.296, P=0.003) were independent protective factors for thrombotic events after clopidogrel treatment; CYP2C19*17 CC type ( OR=2 856.665, 95 %CI: 87.337-93 436.810, P<0.001) was an independent risk factor for thrombotic events after clopidogrel treatment. Conclusion:CYP2C19*2 and CYP2C19*17 mutations are important factors affecting the efficacy of clopidogrel and the occurrence of thrombotic events after treatment in ACS patients.

Objective:To investigate the effect of drug metabolism related gene polymorphism on the efficacy of clopidogrel in patients with acute coronary syndrome (ACS).Methods:The medical records and follow-up records of ACS patients, who were hospitalized in the People′s Hospital of Daxing District between 2017 and 2019, received standardized treatment with aspirin (100 mg/day)+clopidogrel (75 mg/day), and underwent testing for genetic polymorphisms related to clopidogrel absorption/metabolism, were collected. The patients were divided into thrombotic event group and non-thrombotic event group according to whether they experienced thrombotic events such as myocardial infarction, stent thrombosis, and cerebral infarction within 1 year of treatment. The age, gender, smoking history and drinking habits, underlying diseases, drug combination, and alleles related to clopidogrel absorption/metabolism in patients in the 2 groups were compared. The factors affecting the clinical efficacy of clopidogrel was analyzed using logistic regression model.Results:A total of 342 patients were included in the analysis, including 274 males and 68 females, aged (58±9) years; of them, 78 (22.8%) developed thrombotic events. The differences in age, gender, smoking history, drinking history, hypertension, diabetes mellitus, hyperlipidemia, percutaneous coronary intervention history, proportion of combined with calcium channel antagonists, cytochrome P450 (CYP) 2C19*3, paraoxonase-1 Q192R, and adenosine triphosphate binding cassette transporter B1 C3435T between the thrombotic event group and the non-thrombotic event group were not statistically significant (all P>0.05), but the body mass index (BMI), the proportion of CYP2C19*2 GG type and CYP2C19*17 CT type in patients in the thrombotic event group were lower than those in the non-thrombotic event group (all P<0.05), and the proportion of patients with proton pump inhibitor and CYP2C19*17 CC type in the thrombotic event group was higher than that in the non-thrombotic event group (all P<0.05). Multivariate logistic regression analysis showed that high BMI ( OR=0.915, 95 %CI: 0.847-0.989, P=0.026), CYP2C19*2 GG type ( OR=0, 95 %CI: 0-0.008, P<0.001), and GA type ( OR=0.028, 95 %CI: 0.003-0.296, P=0.003) were independent protective factors for thrombotic events after clopidogrel treatment; CYP2C19*17 CC type ( OR=2 856.665, 95 %CI: 87.337-93 436.810, P<0.001) was an independent risk factor for thrombotic events after clopidogrel treatment. Conclusion:CYP2C19*2 and CYP2C19*17 mutations are important factors affecting the efficacy of clopidogrel and the occurrence of thrombotic events after treatment in ACS patients.

Objective:To investigate the diagnostic value of contrast-enhanced ultrasonography (CEUS) in evaluating the severity of renal artery stenosis.Methods:Eighty six patients with suspected renal artery stenosis admitted to Shanxi Provincial People′s Hospital from January 2018 to July 2021 were enrolled in the study. All patients underwent digital subtraction angiography (DSA), Doppler ultrasonography (DUS) and CEUS examinations. With DSA results as gold standard the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS and DUS in the diagnosis of renal artery stenosis were analyzed. The consistency between CEUS and DSA in the diagnosis of renal artery stenosis was evaluated. The accuracy of DUS and CEUS in diagnosis of renal artery stenosis was assessed by the area under receiver operating characteristic (ROC) curve (AUC) and compared between groups.Results:Among 153 renal arteries from 86 patients examined by DSA, 101 showed the stenosis ≥30% (49 left and 52 right renal arteries), and there were 31, 45, 20 and 5 renal arteries with grade I, II, III and IV stenosis. The sensitivity and specificity of DUS in the diagnosis of renal artery stenosis were 74.3% (75/101) and 76.9% (40/52),respectively. DUS showed 21, 42, 20 and 4 renal arteries with grade Ⅰ, Ⅱ, Ⅲ and Ⅳ stenosis, respectively. The sensitivity and specificity of CEUS in the diagnosis of renal artery stenosis were 88.1% (89/101) and 86.5%(45/52), respectively. CEUS showed 26, 43, 23 and 4 renal arteries with grade Ⅰ, Ⅱ, Ⅲ and Ⅳ stenosis, respectively. There was a significant difference between DUS and DSA in grading of renal artery stenosis (χ2=4.447, P=0.03),and there was a moderate consistency between DUS and DSA ( Kappa=0.480). There was no significant difference between CEUS and DSA in grading renal artery stenosis (χ2=0.842, P=0.36) with a good consistency ( Kappa=0.730). The AUC of CEUS in diagnosis of renal artery stenosis was higher than that of DUS [0.873 (95% CI: 0.808-0.938) vs. 0.756 (95% CI:0.673-0.839); Z=4.361, P<0.01]. Conclusion:The study suggests that contrast-enhanced ultrasonography may be used as a diagnostic method for grading renal artery stenosis.

Objective:To analyze the magnetic resonance imaging (MRI) features of diffuse midline gliomas with H3K27M mutation, and to quantitatively analyze the changes of apparent diffusion coefficient (ADC).Methods:The MRI images of 14 cases of diffuse midline gliomas with H3K27M mutation were retrospectively analyzed in the Affiliated Hospital of Qingdao University from April 2017 to November 2019. The location, edge, signal, peritumoral edema and enhancement characteristics of the lesions were observed, and the changes of ADC values were analyzed.Results:The tumors were located in thalamus in four cases, pons in six cases, medulla oblongata in two cases and spinal cord in two cases. In seven cases, the tumor was confined to the midline region, of which six cases had clear boundary, seven cases were located in the midline area, but infiltrated into the non midline area at the same time, and six cases had unclear boundary. Basilar artery entrapment was found in all six patients located in pons. Multiple large cystic changes were found in five cases, multiple small cysts in four cases and no cystic changes in five cases. Cystic changes were found in all seven cases of tumors involving the non midline region, of which six cases were located only in the non midline region, and only two of the seven tumors localized in the midline region had small cysts. Hemorrhage was found in four cases. Five cases showed mild heterogeneous enhancement, six cases showed moderate heterogeneous enhancement, two cases showed obvious enhancement, and one case showed no enhancement. There was no edema around the tumor in nine cases and mild edema in five cases. The average edema index was 1.13. The average ADC value of tumor parenchyma in 12 patients was (7.83±0.88)×10 -4 mm 2/s, which was 15.6% lower than that of the contralateral side [(9.28±0.69)×10 -4 mm 2/s, t=-6.336, P<0.05]. Conclusions:Diffuse midline gliomas with H3K27M mutation have a younger onset age and are more likely to occur in thalamus, brainstem and spinal cord. Most of the tumors have no peritumoral edema or mild peritumoral edema. The tumors confined to the midline region are regular in shape and clear in boundary. The masses involving the non midline area are prone to cystic necrosis. Diffuse midline gliomas with H3K27M mutation in pons are prone to basilar artery entrapment. ADC value can provide a quantitative basis for preoperative tumor grading.

Objective:To analyze the magnetic resonance imaging (MRI) features of epithelioid glioblastoma (eGBM), and to quantitatively analyze the characteristics of apparent diffusion coefficient (ADC) , perfusion-weighted imaging (PWI) and magnetic resonance spectrum (MRS) of eGBM patients.Methods:The MRI results of eight cases of eGBM confirmed by pathology in the Affiliated Hospital of Qingdao University from October 2016 to November 2018 were analyzed retrospectively. The location, edge, signal, peritumoral edema, adjacent meningeal invasion and enhancement of the patients were observed, and the changes of ADC value, relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV) and the ratio of choline (Cho)/N-acetyl-L-aspartic acid (NAA) were analyzed.Results:Among the eight patients, the main tumors were located in temporal lobe ( n=3), frontal lobe ( n=3) and parietal lobe ( n=2). The boundary of the lesion was clear in six cases and unclear in two cases. The lesions were superficial in five cases and in deep white matter in three cases. Bleeding could be seen in four cases. There were three cases with cystic change and four cases with necrosis, and there was no cystic necrosis only in one case. There was no edema around the lesion in one case, severe edema in five cases and moderate edema in two cases. The adjacent meninge was involved in four cases and the ependyma was involved in one case. Two patients had leptomeningeal metastasis within two months after operation. The average ADC value of tumor parenchyma in eight patients was 7.15×10 -4 mm 2/s, which was 17.6% lower than that of the contralateral side. MRS showed that the ratio of Cho/NAA in the lesions of two patients were 5.27, 0.81. PWI showed that the rCBV in the lesions of two patients was 3.51 ml/100 g and 3.32 ml/100 g, respectively, which was 36% and 29% higher than that of the contralateral side, respectively. And the rCBF of the lesions was 31.5 ml·100 g -1·min -1and 82.1 ml·100 g -1·min -1, respectively, which increased by 49% and 203% respectively compared with the contralateral side. Conclusions:eGBM has the characteristics of superficial location, easy to be cystic, but the wall of the cyst is not smooth and uneven, the boundary of the mass is clear, the adjacent meninges are easy to be involved and the meningeal tail sign appears, and it is easy to be spread by cerebrospinal fluid. ADC value, PWI and MRS can provide some help for preoperative tumor grading.

Glioblastoma, which is the most common primary malignant brain tumor, usually occurs in the white matter of the brain. In this case, magnetic resonance imaging (MRI) only showed abnormal cortical signal in the first hospital examination, so he was diagnosed as viral encephalitis. Seven months later, he was admitted to hospital again because of memory loss and slow response. MRI showed obvious mass in the original lesion area. Pathology confirmed glioblastoma (the World Health Organization classification of central nervous system tumors: grade Ⅳ). By analyzing this case, it is considered that some glioblastomas may only have cortical lesions in the early stage. Therefore, if cortical abnormal signals are found, glioblastoma should also be included in the differential diagnosis.

Objective:To assess the clinical value of metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid in pathogenic diagnosis of neurological infectious disease.Methods:Patients who were clinically diagnosed with infectious encephalitis and meningitis and treated in Department of Neurology, Affiliated Hospital of Chifeng University from March 2018 to September 2019 were retrospectively analyzed, including the clinical characteristics and data of mNGS and traditional laboratory test of pathogens.Results:Totally 104 patients with infectious encephalitis and meningitis were eligible for enrollment, and mNGS detected 22 bacterial species(22/104,21.15%), 24 viral species (24/104,23.08%), one fungal species (1/104,0.96%), one parasitic species (1/104,0.96%) and one mycoplasma species (1/104,0.96%).The three leading positive detections were varicella-zoster virus ( n=19), streptococcus ( n=7) and Mycobacterium tuberculosis ( n=4). Combined with traditional pathogen detection methods, clinical manifestations, final diagnosis and treatment results, the number of cases diagnosed by mNGS was 49 cases. The positive rate of the mNGS was 47.12% (49/104).False positives occurred in 21 (20.19%) patients. False negatives occurred in 34 (32.69%) patients. Conclusions:mNGS is more sensitive in evaluating the pathogens causing the infectious encephalitis and meningitis. It has advantages in accurate diagnosis of infectious encephalitis and meningitis.