Objective:To systematically evaluate the qualitative study of perinatal bereavement care by obstetric nurses and midwives, and explore the barriers to perinatal bereavement care, so as to promote the development of domestic perinatal bereavement care services.Methods:Systematic search of qualitative studies on the experience of obstetric nurses and midwives in caring for perinatal bereaved mothers in PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CINAHL, China Biomedical Literature Service System, CNKI, Wanfang Database, and VIP database were searched from the establishment until June 30, 2024. The qualitative research quality evaluation was conducted using the 2016 version of the qualitative research quality assessment tool of the Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, and the results of the study were summarized and integrated using the pooled integration method.Results:A total of 14 studies were included, with 3 Chinese literatures and 11 English literatures. A total of 55 themes were extracted, which were summarized and combined into 8 new categories, and 3 integrated results were summarized: insufficient bereavement care ability, insufficient bereavement care confidence, and imperfect allocation of bereavement care resources.Conclusions:The knowledge popularization and training of bereavement care should be strengthened, the organizational support should be strengthened, the confidence of obstetric nurses and midwives in bereavement care should be enhanced, a special perinatal bereavement care team should be set up, and multidisciplinary resources should be integrated to ensure the continuity and coordination of perinatal bereavement care.

Artery of Percheron(AOP)embolization or occlusion is a rare cerebrovascular disease that can lead to bilateral thalamic infarction with or without involvement of the upper midbrain.Due to its clinical rarity,lack of typical signs of cerebral infarction,and the diversity of patient symptoms,AOP occlusion-induced cerebral infarction is often misdiagnosed or overlooked,which delays the treatment.This article reported a case of a patient who presented with impaired consciousness as the primary symptom and was initially diagnosed with acute top-of-the-basilar artery embolism related cerebral infarction and underwent emergency endovascular thrombectomy,while the emergency angiography revealed an AOP occlusion.This article also analyzed the clinical features,diagnostic challenges,and treatment strategies of AOP occlusion in combination with the literature,with the aim of providing a reference for clinicians in the diagnosis and treatment of such cases.

Facing of mounting resource constraints and rising demands for personalization in medical education,regional anatomy teaching urgently requires transformation.In this paper,we focus on the regional anatomy of the thoracic wall,in order to explore a novel AI-driven teaching paradigm.Anchored in the core principle of"virtual-real integration with cadaveric dissection as the cornerstone,"the paradigm redefines educational objective and constructs an intelligent,closed-loop teaching model integrating students,computers,and instructors.Leveraging the robust support of digital intelligence(e.g.,DeepSeek),this paradigm incorporates interactive method including group collaboration,branching instruction,and gamified assessments.It achieves a comprehensive intelligent transformation of the entire teaching process-from goal setting and plan customization to activity implementation,task completion,outcome exchange,multidimensional evaluation,and reflective iteration.This new paradigm centers on medical students and leverages digital intelligence to activate deep personalized learning potential.It seamlessly integrates fundamental anatomical knowledge with clinical scenarios(e.g.,key anatomy in breast cancer surgery,flap design in breast reconstruction),and significantly enhances clinical decision-making abilities,scientific research and innovative thinking,as well as medical humanistic literacy,paving a new path for intelligent medical education.

Objective To evaluate the reliability and validity and perform cost-consequence analysis of the brief version of the Montreal cognitive assessment(MoCA)for identifying cognitive impairment in a community-based population ≥50 years of age.Methods The internal consistency and retest reliability of the brief version of the MoCA were analyzed,and the area under the curve(AUC),sensitivity,and specificity were determined to discriminate mild cognitive impairment(MCI)and dementia with the clinical dementia rating(CDR)as the diagnostic criterion.The consistency between the brief version and the full version was analyzed by the Kappa test and the Bland-Altman method,and the number of individuals entering the diagnostic assessment and the overall assessment time were estimated and compared between the two versions.Results A total of 303 individuals were included in this study,of whom 192,94,and 17 had normal cognitive function,MCI,and dementia,respectively.The Cronbach's α and re-test coefficients of the brief version of MoCA were 0.754 and 0.711(P<0.001),respectively.The brief version showed the AUC,sensitivity,and specificity of 0.889,74.5%,and 93.8% for identifying MCI,and 0.994,100%,and 93.8% for identifying dementia,respectively.When the brief version of MoCA was used to identify 94 patients with MCI in 303 individuals,107 individuals required additional diagnostic assessment,with an overall assessment time of 142.4 h,which represented decreases of 21.3% and 32.7%,respectively,compared with those of the full version.When the brief version of MoCA was used to identify 17 patients with dementia in 303 individuals,35 individuals required additional diagnostic assessment,with an overall assessment time of 70.4 h,a decrease of 29.5% in the time cost compared with the full version.Conclusions The brief version of MoCA can identify cognitively impaired individuals in a community-based middle-aged and elderly population,with diagnostic validity comparable to that of the full version but less time cost and fewer individuals needing additional diagnostic assessment to detect true-positive cases.It could be expanded for use in the community-based primary screening setting.
Humans ; Aged ; Middle Aged ; Cognitive Dysfunction/diagnosis* ; Male ; Female ; Mental Status and Dementia Tests ; Reproducibility of Results ; Dementia/diagnosis* ; Sensitivity and Specificity ; Aged, 80 and over ; Cost-Benefit Analysis

Objective:To systematically evaluate the qualitative study of perinatal bereavement care by obstetric nurses and midwives, and explore the barriers to perinatal bereavement care, so as to promote the development of domestic perinatal bereavement care services.Methods:Systematic search of qualitative studies on the experience of obstetric nurses and midwives in caring for perinatal bereaved mothers in PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CINAHL, China Biomedical Literature Service System, CNKI, Wanfang Database, and VIP database were searched from the establishment until June 30, 2024. The qualitative research quality evaluation was conducted using the 2016 version of the qualitative research quality assessment tool of the Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, and the results of the study were summarized and integrated using the pooled integration method.Results:A total of 14 studies were included, with 3 Chinese literatures and 11 English literatures. A total of 55 themes were extracted, which were summarized and combined into 8 new categories, and 3 integrated results were summarized: insufficient bereavement care ability, insufficient bereavement care confidence, and imperfect allocation of bereavement care resources.Conclusions:The knowledge popularization and training of bereavement care should be strengthened, the organizational support should be strengthened, the confidence of obstetric nurses and midwives in bereavement care should be enhanced, a special perinatal bereavement care team should be set up, and multidisciplinary resources should be integrated to ensure the continuity and coordination of perinatal bereavement care.

Artery of Percheron(AOP)embolization or occlusion is a rare cerebrovascular disease that can lead to bilateral thalamic infarction with or without involvement of the upper midbrain.Due to its clinical rarity,lack of typical signs of cerebral infarction,and the diversity of patient symptoms,AOP occlusion-induced cerebral infarction is often misdiagnosed or overlooked,which delays the treatment.This article reported a case of a patient who presented with impaired consciousness as the primary symptom and was initially diagnosed with acute top-of-the-basilar artery embolism related cerebral infarction and underwent emergency endovascular thrombectomy,while the emergency angiography revealed an AOP occlusion.This article also analyzed the clinical features,diagnostic challenges,and treatment strategies of AOP occlusion in combination with the literature,with the aim of providing a reference for clinicians in the diagnosis and treatment of such cases.

Aim To establish the fingerprint of raw bupleurum and vinegar bupleurum,investigate the difference in their anti-liver fibrosis effects,and ex-plore the relationship between the chemical composition of raw bupleurum and vinegar bupleurum and their an-ti-liver fibrosis efficacy.Methods The fingerprints of 10 batches of raw bupleuri and 10 batches of bupleuri were established by UPLC method.The liver fibrosis cell model in vitro was established by TGF-β induced LX-2 hepatic stellate cells.The liver fibrosis cell mod-el was analyzed with collagen type Ⅰ(col1a1)and α-smoothmuscleactin.The expression of α-SMA protein was used as the pharmacodynamic index.MetaboAna-lyst5.0 was used to screen the difference markers af-fecting the quality of raw bupledges and vinegar bu-pledges with VIP value＞1 as the criterion.Orthogo-nal partial least squares discriminant analysis(OPLS-DA)was used to screen the main components of raw bupleurum and vinegar bupleurum against liver fibro-sis.Results There were 18 peaks in the UPLC fin-gerprints of raw bupleurum and vinegar bupleurum,and the analysis results showed that there were nine main differences between raw bupleurum and vinegar bupleurum,among which peaks 9,7 and 6 could be considered as bupleurin d,bupleurin a and bupleurin f.The results of spectral effect relationship showed that the main components of bupleurum anti-liver fibrosis were peaks 11,12,14,15 and 18.Conclusions The established fingerprint method of raw bupleurum and vinegar bupleurum is simple and feasible,and the important components of anti-liver fibrosis activity are screened through the spectrum effect relationship,which provides a basis for clarifying the material basis of anti-liver fibrosis effect of raw bupleurum and vine-gar bupleurum.

Objective To analyze the influencing factors for catheter-associated infection(CAI)in chemotherapy treated patients after indwelling peripherally inserted central catheter(PICC)based on a random forest model.Methods 400 tumor patients who received chemotherapy and PICC were selected and divided into the training set(n=300)and the test set(n=100)in a 3∶1 ratio through computer-generated random number.Patients in the training set were subdivided into the non-infection group and the infection group based on the occurrence of infec-tion.Clinical data from two groups of patients were compared.Influencing factors for the occurrence of CAI after PICC were analyzed with multivariate logistic regression model and the integrated classification algorithm of random forest model,and the predictive performance of the two methods was compared.Results Among 300 chemotherapy treated patients in the training set,32 cases(10.67％)experienced CAI.Compared with the non-infection group,patients in the infection group had more single punctures for catheterization,longer PICC retention time,larger pro-portion of catheter movement,larger proportion of complication with diabetes,higher frequency of dressing chan-ges,lower white blood cell count and immune function(all P＜0.05).PICC retention time,catheter movement,complication with diabetes,dressing change frequency,white blood cell(WBC)and immune function were inde-pendent influencing factors for CAI after PICC(all P＜0.05).The random forest model showed that ranking by the importance of different influencing factors was as following:PICC retention time,catheter movement,complication with diabetes,WBC,dressing change frequency and immune function.The integrated classification algorithm of random forest model for predicting the occurrence of CAI in chemotherapy treated patients showed that the area un-der the receiver operating characteristic(ROC)curve(AUC)was 0.872,which had better prediction performance compared with the logistic regression model(AUC=0.791).Conclusion PICC retention time,catheter movement,complicated with diabetes,dressing change frequency,WBC level and immune function are independent influencing factors for CAI in chemotherapy treated patients.The integrated classification algorithm of random forest model can be used to predict CAI in chemotherapy treated patients,and its prediction performance is better than that of the logistic regression model.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective To investigate the clinical effect in treating AO type B and C distal radius fractures with modified Henry approach.Methods Retrospectively analysis of 20 patients with AO type B and C distal radius fractures between June 2021 and May 2022,they were treated by modified Henry approach.There were 6 males and 14 females,aged from 35 to 78 years old,8 patients on the left and 12 on the right.The patients'general data,fracture healing time,postoperative complica-tions,last-time follow up radiographic parameters(volar inclination angle,ulnar deviation angle and radius height),wrist range of motion,range of forearm rotation and functional outcoming of the wrist joint according to Mayo scoring were observed of each patient.Results All patients were followed-up,the time was(13.3±2.3)months,ranged from 12 to 18 months.All the fractures were healed,the fracture healing time was(12.6±2.5)weeks,ranged from 10 to 16 weeks.There were no complications such as poor wound healing,incision infection,iatrogenic median nerve injury,delayed union,nonunion and malunion during the post-operative follow up.According to the X-ray measurement in the last-time follow up,the volar inclination angle was(11.4±4.0)°,the ulnar deviation angle was(20.9±2.2)° and the radius height was(10.3±1.2)mm.The wrist range of motion was(65.3±5.8)° for volar flexion,(60.2±4.2)° for dorsal extension,(37.8±4.1)° for ulnar deviation,(27.0±3.7)° for radial deviation.The range of forearm rotation was(80.4±4.1)° for pronation,(78.6±3.7)° for supination.According to Mayo scoring,the wrist function was evaluated as excellent in 12 cases,good in 6 cases and fair in 2 cases,the excellent and good rate was 90％.Con-clusion Modified Henry approach can better expose the ulnar and volar fragments in distal radius,especially useful for reduct-ing the distal radius with complex bi-columnar fractures.