Objective To explore the constituent elements of patients'sense of gain experience and provide theoretical insights for improving patient satisfaction with healthcare services.Methods Purposive sampling and convenience sampling were employed to select 46 experts in health management from universities,hospitals,government agencies,and academic societies across China for semi-structured interviews.Qualitative analysis of the interview data was conducted using grounded theory.Results Through three-level coding,159 initial concepts,19 categories,7 main categories,and 2 core categories were identified.A conceptual framework for the constituent elements of patients'sense of gain experience was constructed,centered on two core dimensions:micro-level experience and macro-level acquisition.Conclusion The concept of"patients'sense of gain experience"enriches the theoretical framework of"sense of gain"and breaks through the unidimensional approach to evaluating medical service quality.Its enhancement requires collaborative efforts from multiple stakeholders,including medical institutions,governments,policymakers,and other actors.

Objective To investigate the diagnostic value of electromyographic(EMG)tremor indicators for Parkinson's disease(PD)using the Logistic regression model.Methods A total of 65 patients with PD(PD group)and 39 patients with essential tremor(ET)(ET group)were enrolled and underwent EMG tremor analysis.General information,disease-related data,and EMG tremor characteristics were compared between the two groups.Multivariate Logistic regression analysis was performed to screen for independent influencing factors of PD,and receiver operating characteristic(ROC)curves were plotted.The area under the curve(AUC)was used to evaluate the diagnostic value of EMG tremor indicators for PD.Results Compared with the ET group,the PD group had a higher proportion of patients with unilateral onset and those with tremor spectrum frequency≥2 times,and a lower proportion of patients with a family history of tremor(P＜0.05).The tremor peak frequencies in the resting,postural,and weight-bearing(1 000 g)states were lower in the PD group than in the ET group(P＜0.05).There were statistically significant differences in the tremor rhythm patterns between the two groups in the resting and weight-bearing states(P＜0.05),with the PD group dominated by alternating contraction patterns and the ET group by synchronous contraction pat-terns.Multivariate Logistic regression analysis revealed that the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum were independent influencing factors of PD(P＜0.05).The ROC curves showed that the AUCs of the tremor peak frequency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum for diagnosing PD were 0.886,0.750,and 0.779,respec-tively.The combination of these three indicators yielded the highest AUC(0.936)for diagnosing PD,with a sensitivity of 81.54％and a specificity of 94.87％.Conclusion The tremor peak fre-quency in the weight-bearing state,the tremor rhythm pattern in the resting state,and the frequency of tremor spectrum provided by EMG tremor analysis can serve as clinical indicators for early diagno-sis of PD,and their combined use offers higher diagnostic value,which can be used to differentiate PD from ET.

Objective To explore the constituent elements of patients'sense of gain experience and provide theoretical insights for improving patient satisfaction with healthcare services.Methods Purposive sampling and convenience sampling were employed to select 46 experts in health management from universities,hospitals,government agencies,and academic societies across China for semi-structured interviews.Qualitative analysis of the interview data was conducted using grounded theory.Results Through three-level coding,159 initial concepts,19 categories,7 main categories,and 2 core categories were identified.A conceptual framework for the constituent elements of patients'sense of gain experience was constructed,centered on two core dimensions:micro-level experience and macro-level acquisition.Conclusion The concept of"patients'sense of gain experience"enriches the theoretical framework of"sense of gain"and breaks through the unidimensional approach to evaluating medical service quality.Its enhancement requires collaborative efforts from multiple stakeholders,including medical institutions,governments,policymakers,and other actors.

Glycogen storage disease (GSD) - type Ib is an autosomal recessive disease, often accompanied by inflammatory bowel disease. A case of GSD -Ib combined with Crohn′s disease-like enterocolitis is reported. The diagnosis and treatment of this patient is helpful to improve the understanding of this rare disease.

Glycogen storage disease (GSD) - type Ib is an autosomal recessive disease, often accompanied by inflammatory bowel disease. A case of GSD -Ib combined with Crohn′s disease-like enterocolitis is reported. The diagnosis and treatment of this patient is helpful to improve the understanding of this rare disease.

Objective:To establish a model to predict the maintenance efficacy of anti-tumor necrosis factor (TNF) -α monoclonal antibody in active Crohn′s disease (CD) patients with small intestinal involvement.Methods:A retrospective cohort study was carried out. Ninety-eight CD patients with small intestinal involvement admitted in the Tenth People′s Hospital of Tongji University from January 2017 to December 2020 were consecutively included. All the patients received anti-TNF-α monoclonal antibody induction therapy regularly and the induced remission treatment was effective. The maintenance therapy was followed up for at least 1 year. All patients underwent computed tomography enterography (CTE) before treatment. According to whether therapeutic optimization occurred, the patients were divided into optimization group and maintenance group. Univariate analysis was used to compare the differences of clinical and CTE features between the two groups, and multivariate Logistic regression analysis was performed to select the independent factors for medication optimization. A nomogram based on the established predictive model was drawn and further validated internally.Results:During the follow-up, 40 patients underwent treatment optimization and 58 maintained the original treatment. Univariate analysis showed that compared with the maintenance group, the ages of onset[ (35.7±14.3) years old vs. (29.6±12.3) years old, P = 0.027) ] and diagnosis[ (37.7±17.8) years old vs. (30.6±11.1) years old, P = 0.006) ] were older, the level of hemoglobin [ (112.9±23.2) g/L vs. (126.9±26.5) g/L, P = 0.008] and serum albumin [ (38.1±5.0) g/L vs. (42.5±4.9) g/L, P<0.001] was lower in the optimization group, meanwhile the degree of intestinal wall enhancement (mild: 40.0% vs. 74.1%, moderate and severe: 60.0% vs. 25.9%, P = 0.001) and intestinal stenosis (no or suspicious: 47.5% vs. 87.9%, mild: 17.5% vs. 5.2%, moderate and severe: 35.0% vs. 6.9%, P<0.001) were significantly different between two groups. Multivariate analysis revealed that age at diagnosis ( OR = 1.051, 95% CI: 1.009-1.096, P = 0.018) , degree of intestinal wall enhancement ( OR = 3.807, 95% CI: 1.268-11.428, P = 0.017) and moderate-severe intestinal stenosis ( OR = 6.550, 95% CI: 1.640-26.165, P = 0.008) were the independent risk factors for treatment optimization, and high serum albumin level ( OR = 0.841, 95% CI: 0.747-0.946, P = 0.004) was the protective factor. The area under ROC of the established predictive model was 0.856 (95% CI: 0.779-0.933, P<0.001) with sensitivity of 82.5%, specificity of 81.0%, and accuracy of 95.9%. Conclusion:A model is established based on the CTE features including the degree of intestinal wall enhancement and intestinal stenosis combined with age at diagnosis and serum albumin level, it can predict the efficacy of anti-TNF-α monoclonal antibody in maintenance therapy among CD patients with small intestinal involvement.

Objective:To establish a model to predict the maintenance efficacy of anti-tumor necrosis factor (TNF) -α monoclonal antibody in active Crohn′s disease (CD) patients with small intestinal involvement.Methods:A retrospective cohort study was carried out. Ninety-eight CD patients with small intestinal involvement admitted in the Tenth People′s Hospital of Tongji University from January 2017 to December 2020 were consecutively included. All the patients received anti-TNF-α monoclonal antibody induction therapy regularly and the induced remission treatment was effective. The maintenance therapy was followed up for at least 1 year. All patients underwent computed tomography enterography (CTE) before treatment. According to whether therapeutic optimization occurred, the patients were divided into optimization group and maintenance group. Univariate analysis was used to compare the differences of clinical and CTE features between the two groups, and multivariate Logistic regression analysis was performed to select the independent factors for medication optimization. A nomogram based on the established predictive model was drawn and further validated internally.Results:During the follow-up, 40 patients underwent treatment optimization and 58 maintained the original treatment. Univariate analysis showed that compared with the maintenance group, the ages of onset[ (35.7±14.3) years old vs. (29.6±12.3) years old, P = 0.027) ] and diagnosis[ (37.7±17.8) years old vs. (30.6±11.1) years old, P = 0.006) ] were older, the level of hemoglobin [ (112.9±23.2) g/L vs. (126.9±26.5) g/L, P = 0.008] and serum albumin [ (38.1±5.0) g/L vs. (42.5±4.9) g/L, P<0.001] was lower in the optimization group, meanwhile the degree of intestinal wall enhancement (mild: 40.0% vs. 74.1%, moderate and severe: 60.0% vs. 25.9%, P = 0.001) and intestinal stenosis (no or suspicious: 47.5% vs. 87.9%, mild: 17.5% vs. 5.2%, moderate and severe: 35.0% vs. 6.9%, P<0.001) were significantly different between two groups. Multivariate analysis revealed that age at diagnosis ( OR = 1.051, 95% CI: 1.009-1.096, P = 0.018) , degree of intestinal wall enhancement ( OR = 3.807, 95% CI: 1.268-11.428, P = 0.017) and moderate-severe intestinal stenosis ( OR = 6.550, 95% CI: 1.640-26.165, P = 0.008) were the independent risk factors for treatment optimization, and high serum albumin level ( OR = 0.841, 95% CI: 0.747-0.946, P = 0.004) was the protective factor. The area under ROC of the established predictive model was 0.856 (95% CI: 0.779-0.933, P<0.001) with sensitivity of 82.5%, specificity of 81.0%, and accuracy of 95.9%. Conclusion:A model is established based on the CTE features including the degree of intestinal wall enhancement and intestinal stenosis combined with age at diagnosis and serum albumin level, it can predict the efficacy of anti-TNF-α monoclonal antibody in maintenance therapy among CD patients with small intestinal involvement.

Objective:To observe the long-term effects of conventional disease modifying anti-rheumatic drugs (cDMARDs) in the treatment of ankylosing spondylitis (AS) and drug-related adverse reactions, and provide reference to clinical treatment and assessment.Methods:Retrospective analysis was performed for AS patients with more than 10 years follow-up records in the Department of Rheumatology and Immunology, Peking University Shenzhen Hospital. The AS patients enrolled were treated with cDMARDs, non-steroid anti-inflammatory Drugs (NSAIDs), and glucocorticoidsonl only. The treatment group was treated continuously for at least 3 years, and the control group was untreated or treated for less than 3 months. Clinical symptoms, inflammatory indicators, imaging results and drug-related adverse reactions of all patients were collected for statistical analysis. The counting data were tested by χ2 test, the measurement data in normal distribution was tested by t test, and the measurement data that not normally distributed was tested by mann-whitney U test. Paired test was used for statistical processing before and after treatment. Results:A total of 166 eligible patients were included, including 111 in the treatment group and 55 in the control group. There were no statistical significant differences between the treatment group and the control group at baseline including the mean follow-up time, symptomatic disease course, age, sex ratio, human lymphocyte antigen (HLA)-B27 positive rate, duration of morning stiffness, pain at night, peripheral arthritis, ESR, CRP and imaging data. After 10 years, the treat-ment group had shorter morning stiffness[(8±18) vs (22±34), U=2 228, P=0.008], less nocturnal pain [(2/1.9%) vs (19/36.5%), χ2=37.037, P<0.01], lower ESR level [(14±13) vs (20±19), t=2.249, P=0.026], lower CRP level [(6±6) vs (10±11), t=2.154, P=0.033], lower incidence of peripheral arthritis [(23/20.7%) vs(25/45.5%), χ2=10.946, P=0.001] and lower sacroiliac arthritis progression rate [(28/25.2% ) vs (46/83.6%), χ2=50.922, P<0.01], and lower spinal progression rate [(8/7.2%) vs (51/92.7%), χ2=117.407, P<0.01] compared with the control group. The differences between the two groups was statistically significant. The main medications and drug proportions in the treatment group were as follows: sulfasalazine (100%), methotrexate (86.5%), NSAIDs (98.2%), glucocorticoid (78.4%) and thalidomide (62.2%). The main drug-related adverse reactions that occurred during the treatment included dizziness, abnormal menstruation, and reversible liver dysfunction. Conclusion:The combination of cDMARDs can effectively control the clinical symptoms of most AS patients, reduce inflammation indicators, delay the progression of sacroiliac joint and spinal damage, and have no serious drug-related adverse reactions. Almost all of the untreated AS patients have radiographic progression of the sacroiliac joint and spine.

Objective To observe the clinical characteristics of ankylosing spondylitis (AS) patients with hyperuricemia (HUA), and to understand the correlation between AS and HUA, so as to improve the understanding of AS patients with HUA. Methods A retrospective analysis was carried out in patients with the diagnosis with AS from November 2012 to August 2016. Patients were divided into two groups based on complicated with and without HUA. The clinical manifestations, inflammatory indicators, imaging manifest-ations, treatment and outcomes of the two groups were statistically analyzed, and the follow-up results of some patients with HUA were analyzed. The chi-square test was used for the counting data. The measurement data in line with the normal distribution were tested by t test, and the measurement data in non-normal distribution were tested by Mann-Whitney U test. Results Three hundred and sixty-two patients with AS were collected, consisting of 288 males (79.6％) and 74 females (20.4％), aged from 14 to 72 years, a course of disease was 3 months to 40 years. There were 87 cases (24.0％) with hyperuricemia, 77 cases were male (88.5％, 21.3％of all AS patients), and 10 were female (11.5％, 2.8％ of all AS patients). Shorter morning stiffness time [(13 ±31) min and (22 ±48) min, Z=-2.231, P=0.026], lower IgM level [(1.4 ±1.3) g/L and (3.0 ±4.3) g/L, Z=-2.040, P=0.041], and lower erythrocyte sedimentation rate [(25±17) mm/1 h and (33±22) mm/1 h, t=-2.617, P=0.007] in the HUA group when compared with patients without HUA. The difference between the two groups was statistically significant. Four cases (4.6％) had gout arthritis in the group with HUA, all were male, blood uric acid level all>420 μmol/L. There were 7 cases (8.0％) of urolithiasis in the group with HUA, and 24 cases (8.7％) of urolithiasis in the group without HUA, but there was no statistically significant difference in the incidence of urolithiasis between the two groups. None developed hypertensive disease, heart disease, nephropathy, or diabetis. Conclusion The incidence of hyperuricemia is high in AS, and with lower disease activity, and fewer complications.

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.