Objective:To investigate the correlation between multifidus muscle cross-sectional area (CSA), fat infiltration index (FI), and the grading of lumbar facet joint degeneration (FJD).Methods:A retrospective analysis was conducted on the clinical data of 105 patients with lumbar FJD treated at Sichuan Orthopaedic Hospital between January 2015 and December 2020. Patients were divided into three groups according to the Weishaupt grading system: 37 cases with Weishaupt grade 1 (Mild Group), 44 cases with Weishaupt grade 2 (Moderate Group), and 24 cases with Weishaupt grade 3 (Severe Group). Baseline characteristics [sex, age, body mass index (BMI), treatment duration], pathological features at initial diagnosis [segmental distribution, bone mineral density (BMD) T-score, facet joint asymmetry, endplate morphology, Modic classification, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score], and multifidus muscle MRI findings [multifidus cross-sectional area (CSA) and fat infiltration index (FI)] were compared among the three groups. The correlation between lumbar multifidus CSA, FI, and FJD grade was analyzed. Normally distributed measurement data were expressed as xˉ± s; comparisons among multiple groups were performed by one-way ANOVA, pairwise comparisons were performed by LSD- t tests. Counting data were expressed as case (%) and compared by χ2 test. Spearman correlation analysis was used to analyze the correlation between lumbar multifidus MRI parameters and FJD grade. Results:There were no statistically significant differences among the three FJD groups in sex, age, BMI, treatment duration, segmental distribution, BMD T-score, proportion of facet joint asymmetry, endplate morphology, Modic classification, ODI, or JOA score (all P>0.05). At the L4-5 level, the multifidus CSA on the affected side in the severe group was significantly smaller than in the moderate group and mild group [(6.2±1.2) cm2 vs. (7.0±1.1) cm2 vs. (7.8±1.2) cm2], and the CSA in the moderate group was smaller than in the mild group (all P<0.05). At both the L4-5 and L5-S1 levels, the FI on the affected side in the severe group was significantly greater than in the moderate group and mild group [(0.48±0.12) vs. (0.39±0.15) vs. (0.29±0.10) at L4-5; (0.49±0.12) vs. (0.41±0.10) vs. (0.30±0.13) at L5-S1], and the FI in the moderate group was greater than in the mild group (all P<0.05). Spearman correlation analysis showed that at the L4-5 level, multifidus CSA on the affected side was negatively correlated with FJD grade ( r=-0.41, P=0.004). At the L5-S1 level, FI on the affected side was positively correlated with FJD grade ( r=0.58, P<0.001). Conclusion:The CSA and FI of the multifidus muscle on the affected side in the lumbar spine exhibit significant correlations with the severity of FJD grading. Clinically, early functional exercises can be implemented based on the degree of multifidus muscle degeneration observed in patients.

Objective:To examine the therapeutic effects and molecular mechanisms of nuclear receptor NR4A1 in alleviating postoperative ileus (POI) in a rat model.Methods:Twenty-four Sprague-Dawley rats were randomly(random number) divided into four groups ( n=6/group): sham-operated control, POI model, POI model + NR4A1 stimultior (Cytosporone B, 13 mg/kg), and POI model + NR4A1 antagonist (DIM-C-pPhCO2Me, 2 mg/kg). After 24 hours, intestinal tissues and serum were collected for analysis. We assessed: (1) histopathological changes, (2) intestinal motility via propulsion rate, (3) NR4A1 expression by immunohistochemistry, (4) epithelial apoptosis via TUNEL assay, (5) inflammatory cytokines (IL-6, IL-4) by ELISA, (6) tight junction protein (occludin) by Western blot, and (7) p38MAPK/NF-κB pathway activation through combined western blot and immunofluorescence analyses. Results:Compared with sham controls, POI model rats showed (all P<0.05): significantly reduced NR4A1 expression, severe mucosal damage, increased inflammatory infiltration, elevated epithelial apoptosis, decreased occludin expression, impaired intestinal motility, upregulated pro-inflammatory cytokines (IL-6, IL-4), and activated p38MAPK/NF-κB signaling. NR4A1 activation with Cytosporone B significantly reversed these pathological changes (all P<0.05), while NR4A1 inhibition exacerbated them. Conclusions:NR4A1 activation attenuates POI by suppressing p38MAPK/NF-κB-mediated inflammation and preserving intestinal barrier function, suggesting its potential as a therapeutic target for postoperative ileus.

Objective:To investigate the correlation between multifidus muscle cross-sectional area (CSA), fat infiltration index (FI), and the grading of lumbar facet joint degeneration (FJD).Methods:A retrospective analysis was conducted on the clinical data of 105 patients with lumbar FJD treated at Sichuan Orthopaedic Hospital between January 2015 and December 2020. Patients were divided into three groups according to the Weishaupt grading system: 37 cases with Weishaupt grade 1 (Mild Group), 44 cases with Weishaupt grade 2 (Moderate Group), and 24 cases with Weishaupt grade 3 (Severe Group). Baseline characteristics [sex, age, body mass index (BMI), treatment duration], pathological features at initial diagnosis [segmental distribution, bone mineral density (BMD) T-score, facet joint asymmetry, endplate morphology, Modic classification, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score], and multifidus muscle MRI findings [multifidus cross-sectional area (CSA) and fat infiltration index (FI)] were compared among the three groups. The correlation between lumbar multifidus CSA, FI, and FJD grade was analyzed. Normally distributed measurement data were expressed as xˉ± s; comparisons among multiple groups were performed by one-way ANOVA, pairwise comparisons were performed by LSD- t tests. Counting data were expressed as case (%) and compared by χ2 test. Spearman correlation analysis was used to analyze the correlation between lumbar multifidus MRI parameters and FJD grade. Results:There were no statistically significant differences among the three FJD groups in sex, age, BMI, treatment duration, segmental distribution, BMD T-score, proportion of facet joint asymmetry, endplate morphology, Modic classification, ODI, or JOA score (all P>0.05). At the L4-5 level, the multifidus CSA on the affected side in the severe group was significantly smaller than in the moderate group and mild group [(6.2±1.2) cm2 vs. (7.0±1.1) cm2 vs. (7.8±1.2) cm2], and the CSA in the moderate group was smaller than in the mild group (all P<0.05). At both the L4-5 and L5-S1 levels, the FI on the affected side in the severe group was significantly greater than in the moderate group and mild group [(0.48±0.12) vs. (0.39±0.15) vs. (0.29±0.10) at L4-5; (0.49±0.12) vs. (0.41±0.10) vs. (0.30±0.13) at L5-S1], and the FI in the moderate group was greater than in the mild group (all P<0.05). Spearman correlation analysis showed that at the L4-5 level, multifidus CSA on the affected side was negatively correlated with FJD grade ( r=-0.41, P=0.004). At the L5-S1 level, FI on the affected side was positively correlated with FJD grade ( r=0.58, P<0.001). Conclusion:The CSA and FI of the multifidus muscle on the affected side in the lumbar spine exhibit significant correlations with the severity of FJD grading. Clinically, early functional exercises can be implemented based on the degree of multifidus muscle degeneration observed in patients.

Intestinal fibrosis in Crohn′s disease (CD) presents a significant clinical challenge, imposing a substantial burden on patients, their families and society. This article explores the histopathological and pathophysiological changes associated with intestinal fibrosis, providing a detailed summary of the related phenomena and processes. Additionally, we discuss the methods for detecting and assessing intestinal fibrosis, including radiological examinations, histopathological investigations, and the application of serum biomarkers. Finally, we delve into the therapeutic strategies for intestinal fibrosis in CD and the challenges faced in this realm, offering vital insights for further research and treatment of the disease.

With the development of assisted reproductive technology, there will be more and more complex conflicts of interest issues and challenges. This paper used clinical medicine, legal and ethical analysis of WAS syndrome gene mutation assisted reproductive technology cases, emphasized that the law is the bottom line of morality, strengthen the consulting duty of the ethics committee of reproductive medicine, and pointed out that medical staff must fully perform the obligation of notification, respect their autonomy and provide patients with best medical assistance.

Objective:To analyze the correlation between the grouping and weighting of two sets of disease combination systems, namely diagnosis-related groups(DRG) and diagnosis-intervention packet(DIP), and to establish a multidimensional analysis and evaluation mode by applying DRG, DIP, and clinical pathway to guide the standardized diagnosis and treatment and management of disease types.Methods:DRG grouping and DIP simulation full enrollment were applied to patients discharged from a tertiary Grade A general hospital in 2019. The correlation analysis between DRG, DIP, and clinical pathway inclusion(entry), correlation analysis between relative weight of DRG group and DIP standard score, and correlation analysis between clinical pathway entry and cost structure of the two disease groups were conducted by using chi-square test, Pearson correlation analysis, t-test, structural change value, degree of structural change, and incremental contribution rate. Results:Among the 130 395 patients, 41 460 cases entered the clinical pathway, 127 535 cases were enrolled in DRG, and 104 227 cases were enrolled in DIP. There was a correlation between the enrollment of DRG, DIP, and clinical pathway( P<0.05), and there was also a correlation between the relative weight of DRG groups and the enrollment of clinical pathway. The relative weight of the DRG disease group was positively correlated with the DIP standard score( r2=0.761 7, P<0.001). There was a significant difference in hospitalization costs between patients with and without clinical pathway access for some diseases( P<0.05), and different cost categories had different impacts on the total costs. Conclusions:The weight assignment and value orientation of DRG and DIP disease types are consistent, and the multi-dimensional fusion evaluation mode for DRG-DIP-clinical pathway is feasible. The correlation analysis of DRG, DIP, and clinical pathways can serve as the basis for disease classification and cost structure evaluation, which could help to carry out hospital′s refined management and optimize disease structure.

Objective To explore the diagnostic value of magnetic resonance imaging(MRI)and high-frequency ultrasound for synovitis of the hip in children(SHC).Methods A total of 107 children suffering from hip pain were enrolled and underwent MRI and ultrasound examinations.The value of MRI and ultrasound for diagnosing SHC and identifying different types of SHC was analyzed.Results The result consistency between high-frequency ultrasound and clinical diagnosis was higher than that between MRI and clinical diagnosis(Kappa:0.717 vs 0.586).The AUC of the combined detection for diagnosing SHC was greater than that of MRI(0.844 vs 0.812,P<0.05).For the differential diagnosis of different types of SHC,the result consistency between high-frequency ultrasound and clinical diagnosis was higher than that between MRI and clinical diagnosis(Kappa:0.813 vs 0.630).The AUC of high-frequency ultrasound and the combined detection for differentiation between joint swelling type and joint effusion type of SHC was 0.903 and 0.912,higher than 0.815 of MRI(P<0.05).The detection rates of joint space abnormality,joint effusion,joint swelling and joint cartilage changes were 92.45%(49/53),73.91%(17/23),90.70%(39/43),and 77.78%(14/18)when using MRI,and those were 96.23%(51/53),91.30%(21/23),95.35%(41/43),and 88.89%(16/18)when using high-frequency ultrasound.There was no significant difference in the detection rates of pathological changes such as joint space abnormality between the two methods(P>0.05).Conclusion The combined detection of MRI and high-frequency ultrasound has high diagnostic value for SHC.

Metaphors serve as important linguistic tools in doctor-patient communication,especially in describing and elucidating medical conditions to patients.Metaphors are widely used in doctor-patient communication because they represent complex medical terminology and diagnostic information in a more vivid and comprehensible way,which allows patients to understand and accept what doctors intend to convey.Also,doctors use metaphors to alleviate patients' fear and anxiety,thus enhancing trust and cooperation between them.However,it is noted that some challenges should be considered.In other words,the misuse of metaphors may cause misunderstandings,which could compromise the effectiveness of treatments.In this context,the proper use of metaphors is a significant issue in linguistics and communication studies.The development of philosophy of language not only offers various approaches to account for metaphors but also raises some issues in how doctors and patients understand metaphors.One point relates to the indeterminacy of metaphors,which means a single metaphor could have multiple interpretations.If this occurs,a patient may become confused when a doctor utters a metaphor.Another point involves the presuppositions in metaphors,which emphasize the implicit assumptions or background knowledge that a metaphor relies on for its interpretation.These presuppositions influence how a patient understands a metaphor.If the patient does not share the same presuppositions as the doctor,they may misunderstand what the doctor intends to convey.The aim of this paper is to address the challenges of metaphor use in doctor-patient communication through theoretical analysis,thereby fostering harmonious doctor-patient relationships and improving the quality and effectiveness of healthcare services.

Objective To observe the clinical and imaging features of invasive Klebsiella pneumoniae liver abscess syndrome(IKPLAS).Methods Data of 68 patients with Klebsiella pneumoniae liver abscess(KPLA)were retrospectively analyzed.The patients were divided into IKPLAS group(n=25)or non-IKPLAS group(n=43)according to extrahepatic invasive infection or not.Clinical data as well as CT and/or MRI findings were compared between groups.Results The patients'age was lower,while glycated hemoglobin and D-dimer levels were higher in IKPLAS group than those in non-IKPLAS group(all P＜0.05).Hepatic venous thrombophlebitis was detected in 18 cases in IKPLAS group and 6 cases in non-IKPLAS group,while arterial phase abnormal high perfusion around abscess was noticed in 10 cases in IKPLAS group and 28 cases in non-IKPLAS group,both being significantly different between groups(both P＜0.05).The extrahepatic infection in IKPLAS group mainly observed in lungs(19/25,76.00%).Conclusion The ages were lower,while glycated hemoglobin and D-dimer levels were both higher in IKPLAS than in the other KPLA patients.Often appeared hepatic venous thrombophlebitis and extrahepatic infection mainly affecting lungs were imaging characteristics of IKPLAS.

Specialist nurses play an increasingly important role in clinical,and at the same time,they(especially enterostomal therapists/wound stoma specialist nurses)are often troubled by ethical problems when facing patients independently.Based on the"structured analysis form of clinical nursing ethics"constructed in the early stage,this paper used a case study method,took a chronic wound patient with postpartum fat liquefaction combined with thread-knot reaction as an example,conducted an in-depth analysis and reflection on the ethical problems of enterostomal therapists choosing treatment plans in clinical work,as well as proposed clinical recommendations.Base on this,this paper suggests that specialist nurses should fully consider the wishes and background characteristics of patients when nursing and treating patients,and use the four-box model of ethical analysis to analyze and solve ethical conflicts.