Objective:There is a lack of scientifically validated tools to measure the knowledge attitude and practice(KAP)of informal caregivers for patients with pressure injury(PI).This study aims to develop a KAP Scale for Informal Caregivers of PI Patients and to evaluate its reliability and validity. Methods:Based on the KAP theory framework and relevant literature,an initial pool of items was created through expert brainstorming sessions.The initial scale was formed after a Delphi expert consultation and a preliminary survey.From April to October 2023,a convenient sample of informal caregivers for PI patients was recruited from an inpatient department of the Third Xiangya Hospital of Central South University,as well as its associated community and nursing homes.The first round included 186 participants,and the second round included 213 participants,who were used for item analysis and reliability and validity testing.After a 3-week interval,20 participants from the initial group were randomly selected for a retest to assess the test-retest reliability of the scale. Results:The KAP Scale for informal caregivers of PI patients consists of 3 dimensions with 19 items.The overall internal consistency(Cronbach's α)of the scale was 0.916.The item-level content validity index(I-CVI)ranged from 0.826 to 1.000,and the scale level-content validity index/average(S-CVI/Ave)was 0.94.Exploratory factor analysis extracted 3 common factors,accounting for 64.643％of the total variance.Confirmatory factor analysis showed that the model fit the data well,with x2/df=2.54,root mean square error of approximation(RMSEA)=0.085,comparative fit index(CFI)=0.920,and standardized root mean square residual(SRMR)=0.059. Conclusion:The KAP scale for informal caregivers of PI patients demonstrates good reliability and validity and can be used to assess the KAP levels of informal caregivers regarding PI.

Background::Bladder cancer, characterized by a high potential of tumor recurrence, has high lifelong monitoring and treatment costs. To date, tumor cells with intrinsic softness have been identified to function as cancer stem cells in several cancer types. Nonetheless, the existence of soft tumor cells in bladder tumors remains elusive. Thus, our study aimed to develop a microbarrier microfluidic chip to efficiently isolate deformable tumor cells from distinct types of bladder cancer cells.Methods::The stiffness of bladder cancer cells was determined by atomic force microscopy (AFM). The modified microfluidic chip was utilized to separate soft cells, and the 3D Matrigel culture system was to maintain the softness of tumor cells. Expression patterns of integrin β8 (ITGB8), protein kinase B (AKT), and mammalian target of rapamycin (mTOR) were determined by Western blotting. Double immunostaining was conducted to examine the interaction between F-actin and tripartite motif containing 59 (TRIM59). The stem-cell-like characteristics of soft cells were explored by colony formation assay and in vivo studies upon xenografted tumor models. Results::Using our newly designed microfluidic approach, we identified a small fraction of soft tumor cells in bladder cancer cells. More importantly, the existence of soft tumor cells was confirmed in clinical human bladder cancer specimens, in which the number of soft tumor cells was associated with tumor relapse. Furthermore, we demonstrated that the biomechanical stimuli arising from 3D Matrigel activated the F-actin/ITGB8/TRIM59/AKT/mTOR/glycolysis pathways to enhance the softness and tumorigenic capacity of tumor cells. Simultaneously, we detected a remarkable up-regulation in ITGB8, TRIM59, and phospho-AKT in clinical bladder recurrent tumors compared with their non-recurrent counterparts.Conclusions::The ITGB8/TRIM59/AKT/mTOR/glycolysis axis plays a crucial role in modulating tumor softness and stemness. Meanwhile, the soft tumor cells become more sensitive to chemotherapy after stiffening, that offers new insights for hampering tumor progression and recurrence.

Objective:The rehabilitation work for patients with motor dysfunction after stroke is crucial.However,there is currently a lack of summarized evidence regarding the rehabilitation management of stroke patients in rehabilitation wards,communities,and at home.This study aims to compile relevant evidence on the rehabilitation management of patients with motor dysfunction after stroke,providing a reference for clinical and community health professionals to carry out rehabilitation interventions. Methods:A systematic search was conducted in BMJ Best Practice,UpToDate,National Guidebook Clearinghouse,American Heart Association/American Stroke Association,Canadian Medical Association,National Institute for Health and Clinical Excellence,United States Department of Veterans Affairs/Department of Defense,Registered Nurses Association of Ontario,JBI Evidence-Based Healthcare Center Database,The Cochrane Library,PubMed,Web of Science,Embase,CINAHL,CNKI,Wanfang Database,SinoMed,and other databases for all literature on the rehabilitation management of patients with motor dysfunction after stroke.This included clinical decision-making,guidelines,expert consensuses,recommended practices,systematic reviews,and evidence summaries,with the search period spanning from the establishment of each database to October 2023.Two researchers independently evaluated the quality of the literature. Results:A total of twenty-one documents were included,consisting of 11 guidelines,2 expert consensus,and 8 systematic reviews.Evidence was extracted and integrated from the included literature,summarizing forty-five pieces of evidence across nine areas:rehabilitation management model,rehabilitation institutions,rehabilitation teams,timing of rehabilitation interventions,rehabilitation assessment,rehabilitation programs,rehabilitation duration and frequency,rehabilitation intensity,and rehabilitation support These covered comprehensive rehabilitation management content for stroke patients in the early,subacute,and chronic phases. Conclusion:The best evidence summarized in this study for the rehabilitation management of patients with motor dysfunction after stroke is comprehensive and of high quality.It provides important guidance for clinical and community healthcare professionals in carrying out rehabilitation interventions.When applying the evidence,it is recommended to consider the current condition of the stroke patient,the extent of motor dysfunction,environmental factors,and the patient's preferences.Then,select the most appropriate rehabilitation plan,and adjust the type and intensity of training according to each patient's specific needs and preferences.

The cartilage-protective effect of ginkgolide C(GC)on the two modeling modalities was investigated based on joint pain,degree of cartilage pathology,ECM degradation process,and level of inflammatory mediator production in rats.Twenty-five SD rats were selected and randomly di-vided into five groups:the control group(Control group),model 1 group(ACLT group),adminis-tration 1 group(ACLT+GC group),model 2 group(MIA group),and administration 2 group(MIA+GC group.)The rats were euthanized after 4 weeks of the test.Femur,tibia and blood samples were collected from the right hind limb of rats.The degree of pathology in the femur and tibia of rats was assessed by saffron O solid green staining and OARSI score.Immunohistochemis-try was used to detect the expression levels of collagen Ⅱ and MMP-13 in cartilage.ELISA was used to detect the changes in the levels of MMP-3,MMP-13,CTX-Ⅱ,COMP,COX-2,INOS,IL-1β,and TNF-α in the serum of rats.Cold sensitivity test and knee extension vocalization test were conducted to detect the degree of joint pain in rats.ACLT could cause more severe structural dam-age to articular cartilage compared with the MIA group.The OARSI scores and the expression of MMP-13 in femur and tibia,and the serum levels of MMP-13,MMP-3,CTX-Ⅱ,and COMP were higher in the ACLT group than those in the MIA group.However,the levels of inflammatory me-diators COX-2,IL-1β,and TNF-α were significantly lower in the ACLT group than in the MIA group(P＜0.0l).GC intervention reduced the OARSI score(P＜0.05 or P＜0.01)and pain scores,inhibited the ECM matrix degrading enzymes(MMP-13,MMP-3),cartilage metabolism markers(CTX-11,COMP),and inflammatory mediators(COX-2,INOS,IL-1β and TNF-α)ex-pression,and promoted collagen Ⅱ synthesis.Both modeling methods resulted in cartilage damage.In particular,the OA model constructed by ACLT+PMMx method in rats had obvious joint dam-age,which was favorable to investigate the degree of cartilage structural damage.GC attenuated cartilage pathological changes,pain severity and inflammatory response in the rat OA model in both groups,thus exerting a cartilage-protective effect.

Objective:To investigate the clinical application effect of internal mammary artery perforator (IMAP) as recipient vessels in breast reconstruction with deep inferior epigastric perforator flap (DIEPF) immediately after breast cancer surgery.Methods:From May 2020 to May 2023, a total of 18 patients with DIEPF breast reconstruction using IMAP as recipient vessels were selected from the Department of Breast Disease of Henan Cancer Hospital. The patients were 31 to 50 years old, with an average of 41.5 years old. The stages of breast cancer were cT is/1-2N 0-2M 0, and all of the patients received immediate breast reconstruction after the breast cancer surgery. The size of flaps were from 9.0 cm × 26.0 cm to 15.0 cm × 38.0 cm. Preoperative chest and abdominal wall CTA were performed to identify the location of intercostal space and the calibre of IMAP. Intraoperatively, the number of IMAP, the diameters of corresponding arteries and accompanying veins in the recipient site were recorded. All patients were included in the scheduled postoperative follow-up through outpatient clinic or via WeChat. The quality of flap survival was evaluated, the condition of breast appearance and recovery of the abdominal donor site were evaluated according to the breast cancer patient reported outcome measures (BREAST-Q). Results:All the 18 patients had the IMAP visualised in surgery, with 13 had the IMAP located at the second intercostal space and 3 at the third intercostal space. The other 2 patients were found with the IMAP located in both the second and third intercostal spaces, in which 1 was found that both of IMAP were suitable for anastomosis. It was also found that there was 1 accompanying vein in 15 breasts and 2 accompanying veins in 2 breasts. One breast had found without an accompanying vein. The diameters of arteries were 1.1 mm±0.1 mm and that of the veins were 1.8 mm±0.3 mm. The average follow-up period was 28 months, ranged from 6 to 40 months. Of the 18 flaps, 17 were completely survived. Venous compromise occurred in 1 flap due to extensive venous thrombosis, and it was replaced with a breast implant. No patient experienced concave deformities in the reconstructed breasts. Seventeen patients with an average BREAST-Q score of 94.4. One patient with a BREAST-Q score of 79.0.Conclusion:IMAP can serve as a reliable recipient vessel for immediate breast reconstruction with DIEPF after breast cancer surgery. With strict selection criteria, this technique could be put on further trials with larger sample size and multi-centres.

To enhance the learning stickiness, improve low completion rate of online teaching, and promote teaching quality has become the key to solve the contradiction in online teaching. In this paper, taking the teaching of biochemistry as example, based on the trigger mechanism, maintenance mechanism and migration mechanism of sticky learning, guided by the three-dimensional goal of "knowledge and skills, process and method, emotional attitude and values", the BOPPPS (bridge-in, objective, pre-assessment, participatory-learning, post-assessment, summary) teaching model was combined with online teaching. According to the interactive behavior in the course learning space, the Spearman rank correlation analysis was performed by SPSS 18.0 software to comprehensively evaluate the learning stickiness degree. The research has found that, due to its "micro but refined, compact structure and student-centered" characteristics, BOPPPS combining with online teaching can effectively make up for the time and space limitations of offline teaching and the excessively broad online teaching, bring benefits from the perspectives of "inclusion, attraction and production", promote students' active learning, and practically improve learning stickiness. The research provides a new idea for creating online "golden" courses.

Objective:To evaluate the effects of remimazolam on gastrointestinal motor function in the patients undergoing gastrointestinal endoscopy.Methods:A total of 262 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-64 yr, with body mass index of 18-28 kg/m 2, scheduled for elective gastrointestinal endoscopy from May 2022 to August 2022, were divided into 2 groups ( n=131 each) using a random number table method: remimazolam group (group R) and propofol group (group P). The patients in group R received intravenous remimazolam 0.20-0.25 mg/kg, and patients in group P received intravenous propofol 1.5-2.0 mg/kg. The gastrointestinal endoscopy was performed when the patients′ Modified Observer′s Assessment of Alertness/Sedation scores ≤3. During fasting before gastrointestinal preparation, before gastrointestinal endoscopy and while leaving the post-anesthesia care unit (PACU), the concentrations of serum motilin and gastrin were measured by enzyme-linked immunosorbent assay, the intestinal peristalsis rating assessed by the endoscopist during the examination was recorded, the occurrence of hypotension and hypoxemia during the examination and occurrence of abdominal distension, abdominal pain, and nausea and vomiting during stay in PACU were recorded. Results:Compared with group P, the intestinal peristalsis rating was significantly increased, the serum motilin and gastrin concentrations were increased while leaving PACU, the incidence of hypotension and hypoxemia was decreased during the examination, and the incidence of abdominal distention was decreased during stay in PACU in group R ( P<0.05). Conclusions:Remimazolam has a milder inhibitory effect on secretion of gastrointestinal hormones than propofol in the patients undergoing gastrointestinal endoscopy and is helpful for the recovery of gastrointestinal motility.

Objective:To investigate the repair of the severe nasal deformity in the unilateral cleft lip secondary with the methods in the composite tissue Z-plasty and the nasolabial anatomical reconstruction.Methods:A total of 25 patients with severe nasal deformity due to secondary unilateral cleft lip underwent the reconstructive surgery using the technique of composite tissue Z-plasty and the nasolabial anatomical reconstruction for anatomical restoration of cartilage, muscle, and soft tissue layers. All patients were followed up for 3-24 months, with an average period of 7.6 months. The treatment outcomes were evaluated by a questionnaire in postoperative follow-up.Results:All the 25 patients had achieved satisfactory nostril shape and no other complications such as bleeding, infection and flap necrosis were recorded. A total of 25 patients were evaluated postoperatively. The average columella length was significantly improved from an average of 14.2 mm preoperatively to 20.2 mm postoperatively. The average ratio of the cleft side columella height to the alar base width was 0.18 preoperatively and 0.30 postoperatively. The postoperative basal and frontal views revealed a better shape of the nostrils, columella and nasal floor. GAIS questionnaires of 25 patients demonstrated that 20 patients reported great improvement, 4 patients reported moderate improvement, 1 patient had poor improvement in size and shape of the affected side nostril who undevwent the another repair of the rdure in 12 months postoperation. The ectopic muscles around the pear hole was completely released and the effect was good after repair. The satisfactory rate was 96%.Conclusions:Combining the composite tissue Z-plasty with the nasolabial anatomical reconstruction allows for thorough anatomical restoration of cartilage, muscle, and skin layers in unilateral cleftlip nasal deformities. This single-step approach is a safe and technically easy therapeutic option that is associated with high patients′ satisfaction. This method should be considered for promotion in clinic.

Objective:This study aims to analyze the efficacy and safety of anlotinib in the real world for patients with unresectable or metastatic bone and soft-tissue sarcomas(STSs). Methods:Clinical data of 124 patients with unresectable or metastatic bone and STSs treated with anlotinib in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were retrospectively analyzed.Information on age,sex,performance status,lines of anlotinib,surgical history,reduction of anlotinib,adverse reaction,metastatic site,tumor location,pathological subtypes and combination chemotherapy was collected and analyzed.The objective response rate(ORR)and disease control rate(DCR)was analyzed for short-term efficacy.Kaplan-Meier method was performed for survival analysis,and the evaluation indexes were median progression-free survival(mPFS)and median overall survival(mOS). Results:The main pathological subtypes of 124 patients were Synovial sarcoma(SS),Leiomyosarcoma(LMS),liposarcoma(LPS).The median age was 48.5 years(9-83 years).The ORR and DCR of anlotinib used in first-line therapy were 26.8％and 82.1％,but in second-line therapy and beyond,the ORR and DCR only were 5.9％and 64.7％.There were improvement in mPFS and mOS with anlotinib in first-line therapy compared to second-line therapy and beyond(mPFS:22.0 months vs 7.0 months,P=0.001;mOS:51.0 months vs 32.0 months,P=0.035).Adverse reactions of anlotinib were well tolerated,and the main grades of adverse reactions were grade Ⅰ and Ⅱ.No new anlotinib-related adverse reactions were identified. Conclusion:Anlotinib has shown a definite effect in the treatment of unresectable or metastatic bone and STSs.The adverse events of anlotinib are minor and well tolerated,and the efficacy of first-line treatment is better.

Objective:To explore the ideal way of using the stereoscopic unequal S-plasty in reconstruction of the congenital hypoplastic ear lobe cleft with soft tissue deficiency.Methods:Data of 10 patients with the congenital hypoplastic ear lobe cleft associated with soft tissue deficiency who were treated using the stereoscopic unequal S-plasty in the plastic cosmetic surgery of Xuzhou Central Hospital from Aug 2018 to Aug 2022 were retrospectively analyzed. Six patients were male, 4 were female. Their ages ranged from 6 years to 19 years old, with a mean age of 13 years. Lobe deficiency size ranged from 0.8 cm×0.5 cm to 1.2 cm×1.0 cm.Results:The post-operation flaps had no venous congestion, infection or necrosises. During 3 to 12 months of follow-up, the technique made the shape of the ear lobe smoother. The incisions left inconspicuous scars. The result was satisfactory in terms of matching the contralateral normal ear lobe in shape and symmetry. Doctors and patients were satisfied with the results.Conclusions:The stereoscopic unequal S-plasty is an effective way to correct the the severe congenital ear lobe deformity. The good result,simple manipulation and short operation time are the advantages of this method.