AIM: To compare the clinical efficacy of goniosynechialysis versus trabeculectomy combined with cataract phacoemulsification in treating glaucoma complicated with cataract.METHODS:From January 2019 to January 2024, patients with glaucoma complicated with cataract diagnosed in our hospital were included as the study subjects. They were assigned into trabeculectomy group and goniosynechialysis group based on different surgical methods. The trabeculectomy group was treated with cataract phacoemulsification combined with trabeculectomy, while the goniosynechialysis group was treated with cataract phacoemulsification combined with goniosynechialysis. The improvement of visual acuity, anterior chamber depth, chamber angle width, intraocular pressure, whole en face vessel density within the optic disc head and in the peripapillary region, and complications were compared between two groups.RESULTS: A total of 120 patients(120 eyes)with glaucoma combined with cataract were included in this study, among which 60 eyes were in the trabeculectomy group and 60 eyes in the goniosynechialysis group. The age of the trabeculectomy group was 60.72±6.16 years, including 28 males and 32 females. The age of the goniosynechialysis group was 61.04±6.24 years, including 31 males and 29 females. At 3 mo after surgery, the visual acuity of patients in both groups improved significantly, and the improvement of visual acuity in the goniosynechialysis group was significantly better than that in the trabeculectomy group(all P<0.01). At 3 mo after surgery, the anterior chamber depth and chamber angle width of patients in both groups were higher than those before surgery, and with the goniosynechialysis group being higher than the trabeculectomy group(all P<0.01), while the intraocular pressure was lower than that before surgery, and with the goniosynechialysis group being lower than the trabeculectomy group(all P<0.01). Before surgery, there was no significant difference in the whole en face vessel density within the optic disc head between the two groups(P>0.05), however, the whole en face vessel density within the optic disc head in both groups on 1 d after surgery were significantly lower than before surgery(all P<0.05); and compared with 1 d after surgery, there was a significant increase at 1 wk, 1, and 3 mo after surgery(all P<0.05); the whole en face vessel density within the optic disc head in the goniosynechialysis group was significantly higher than that in the trabeculectomy group at various time points after surgery(all P<0.05). However, there was no significant difference in the whole en face vessel density in the peripapillary region between the two groups before surgery and various time points after surgery(all P>0.05). Within 3 mo after surgery, the incidence of complications in the goniosynechialysis group(8.3%)was significantly lower than that in the trabeculectomy group(21.7%; P<0.05).CONCLUSION:Goniosynechialysis combined with phacoemulsification is more effective than trabeculectomy combined with phacoemulsification in the treatment of patients with glaucoma complicated with cataract in improving the visual acuity and whole en face vessel density within the optic disc head of patients, increasing the anterior chamber depth and chamber angle width, reducing intraocular pressure and the risk of complications. It has high safety and ideal short-term efficacy.

Objective To explore the risk factors of progression to dementia within 2 years in patients with recent subcortical small infarction (RSSI) complicated with cognitive dysfunction. Methods A total of 340 patients with RSSI complicated with cognitive dysfunction who were treated in the hospital and completed 2-year follow-up were selected from February 2021 to February 2025. According to whether the patients progressed to dementia, they were classified into dementia group (n=105) and non-dementia group (n=235). The clinical data were compared between both groups, and the independent risk factors were screened by Logistic regression analysis. Results Multivariate logistic regression analysis suggested that history of hypertension (OR=1.919), history of diabetes mellitus (OR=1.597), multiple infarctions (OR=1.455), severe white matter lesions (OR=1.595), no cognitive function training (OR=1.923), increased infarct size (OR=1.069), reduced MMSE score (OR=0.945) and increased levels of NfL (OR=1.049) and IL-6 (OR=1.038) were independent risk factors for the progression to dementia (all P<0.05). Conclusion The progression to dementia in patients with recent subcortical small infarction and cognitive dysfunction is affected by multiple factors. In clinical practice, the integration of vascular risk factors, imaging features, cognitive assessment and serum biomarkers (NfL, IL-6) helps to construct an early risk prediction model and implement targeted interventions for high-risk groups.

OBJECTIVE To explore the application of multiple hospital branches management mode in control of risk of hospital-acqueird infections in a general hospital so as to move forward the infection control threshold.METHODS The risk management closed loop,known as the infection index monitoring-risk assessment-risk re-sponse-effect evaluation-infection index monitoring,was adopted by People's Hospital of Ningxia Hui Autono-mous Region from Jan.to Jun.2024.The risk of infection at different levels of hospital zones,disciplines,clinical departments and risk indices was evaluated by risk matrix method.The correlation between the risk indices of clin-ical department and the risk scores was observed,and the dynamic monitoring was carried out for the change of risk of infection in the clinical departments.RESULTS The risk score was higher in the headquarter and Ningnan Branch than in the Xixia branch;the interquartile range(IQR)value from high to low was as follows:Xixia branch,hospital headquarter,Ningnan branch.The intensive care unit(ICU),nerve center and radiotherapy de-partment were the disciplines at extremely high risk of infection.The ICU,cardiac vascular surgery department and gastroenterology department of the hospital headquarters,the ICU,neurosurgery department and neurology department of Ningnan branch and the ICU and cardiac vascular surgery department of Xixia branch were the de-partments at extremely high risk of infection.The etiological submission rate before drug therapy,implementation of prevention measures for multidrug-resistant organisms(MDROs),cleaning and disinfection and missing report of hospital-acqueird infection cases were the major supervision indices.The absolute values of Spearman related co-efficient between clinical department risk scores and 4 indices-including the isolation rate of MDROs and the inci-dence of hospital-acqueird infection was greater than 0.5.CONCLUSION The risk management closed loop that is applied in the 'one hospital and multiple branches' medical institution may facilitate the dynamic monitoring,as-sessment and intervention the high-risk hospital branches,disciplines,departments and indices,and boost the ca-pability of risk management of infections in medical institutions.

BACKGROUND:The definitive cause of adolescent idiopathic scoliosis is not yet known.The search for a clinical approach to address adolescent idiopathic scoliosis is imminent.OBJECTIVE:To investigate the effect of Schroth therapy combined with core strength training on mild adolescent idiopathic scoliosis and to provide more bases for the clinical treatment of mild adolescent idiopathic scoliosis.METHODS:110 patients with mild adolescent idiopathic scoliosis attending the Department of Rehabilitation Medicine and Department of Spine Surgery of Affiliated Hospital of Nantong University from July 2022 to January 2024 were selected as the study subjects.They were divided into the trial group and the control group according to the wishes of the patients and their parents,with 55 cases in each group.The control group was observed and followed up,and the trial group underwent Schroth therapy combined with core strength training for 45 minutes a day for 24 weeks.The differences in imaging parameters,body surface indexes,three-dimensional ultrasound imaging angle,and quality of life were compared between the two groups before and after treatment.RESULTS AND CONCLUSION:(1)At 24 weeks after treatment,major curve Cobb,apical vertebral translation,and cervical lordosis were significantly improved in the trial group(P＜0.05),while there was no significant difference in the control group(P＞0.05).Major curve Cobb and apical vertebral translation in the trial group were significantly better than those in the control group(P＜0.05).(2)At 24 weeks after treatment,angle of trunk rotation in the trial group was significantly lower than that before treatment(P＜0.05),while there was no significant difference between before and after treatment in the control group(P＞0.05),and angle of trunk rotation in the trial group was significantly lower than that of the control group(P＜0.05).(3)At 24 weeks after treatment,the center of laminae angle of three-dimensional ultrasound imaging was significantly reduced in the trial group(P＜0.05),while there was no significant difference in the control group before and after treatment(P＞0.05).The center of laminae angle of three-dimensional ultrasound imaging was smaller in the trial group than that in the control group(P＜0.05).(4)At 24 weeks after treatment,in terms of the quality of life,pain dimension score in the trial group was significantly increased(P＜0.05).Both trial and control groups showed significantly higher scores in the self-image dimension compared with that before treatment(P＜0.05).Both groups had significantly lower scores in the mental health dimension compared with that before treatment(P＜0.05).In the dimensions of pain,self-image,mental health,and satisfaction,the trial group was significantly higher than the control group(P＜0.05).(5)It is indicated that Schroth therapy combined with core strength training can improve the major curve Cobb,apical vertebral translation,and cervical lordosis angle,reduce the angle of trunk rotation,decrease the center of laminae angle of three-dimensional ultrasound imaging,and improve the quality of life,and it is effective in the treatment of mild adolescent idiopathic scoliosis.

Strangles,caused by Streptococcus equi subsp.equi,remains one of the most prevalent and high-incidence infectious diseases in intensive donkey farms,posing a significant threat to the healthy development of the donkey industry.Vaccination serves as an effective measure for the pre-vention and control of the disease,however,there is currently no attenuated vaccine against this disease in China.To provide a candidate strain for the development of a live attenuated strangles vaccine,this study focused on a wild-type S.equi subsp.equi strain isolated from donkeys.Using homologous recombination gene knockout technology,the aroA gene(encoding 5-enolpyru-vylshikimate-3-phosphate synthase)and the sag A gene(encoding the precursor of streptolysin S toxin)were sequentially deleted to construct a double-gene-deletion strain(ΔsagA/aroA).The virulence and key biological characteristics of the mutant strain were systematically evaluated.TheΔsagA/aroA strain was successfully generated,exhibiting complete loss of hemolytic activity and maintaining stable genetic inheritance over 60 consecutive passages.Electron microscopy revealed that the mutant retained morphological characteristics compared to the wild-type strain,and its growth rate was significantly slower(P＜0.000 1).Virulence assessment using a challenge dose of 1× 105 CFU/0.2 mL(the minimum fully lethal dose of the wild-type strain)demonstrated markedly attenuated virulence in the mutant.Immunization trials with 1 ×104 CFU/0.2 mL of theΔsagA/aroA strain revealed a increase in ELISA antibody titers by day 7 post-vaccination,and higher levels at days 14 and 21.Notably,antibody levels in the experimental group were significant-ly higher than those in the control group(P＜0.000 1).These findings confirm that the double-gene-deletion strain S.equi subsp.equi ΔsagA/aroA exhibits reduced virulence while retaining im-munogenicity,which suggested it can be used as a promising candidate strain for further develop-ment of a live attenuated strangles vaccine.

Strangles,caused by Streptococcus equi subsp.equi,remains one of the most prevalent and high-incidence infectious diseases in intensive donkey farms,posing a significant threat to the healthy development of the donkey industry.Vaccination serves as an effective measure for the pre-vention and control of the disease,however,there is currently no attenuated vaccine against this disease in China.To provide a candidate strain for the development of a live attenuated strangles vaccine,this study focused on a wild-type S.equi subsp.equi strain isolated from donkeys.Using homologous recombination gene knockout technology,the aroA gene(encoding 5-enolpyru-vylshikimate-3-phosphate synthase)and the sag A gene(encoding the precursor of streptolysin S toxin)were sequentially deleted to construct a double-gene-deletion strain(ΔsagA/aroA).The virulence and key biological characteristics of the mutant strain were systematically evaluated.TheΔsagA/aroA strain was successfully generated,exhibiting complete loss of hemolytic activity and maintaining stable genetic inheritance over 60 consecutive passages.Electron microscopy revealed that the mutant retained morphological characteristics compared to the wild-type strain,and its growth rate was significantly slower(P＜0.000 1).Virulence assessment using a challenge dose of 1× 105 CFU/0.2 mL(the minimum fully lethal dose of the wild-type strain)demonstrated markedly attenuated virulence in the mutant.Immunization trials with 1 ×104 CFU/0.2 mL of theΔsagA/aroA strain revealed a increase in ELISA antibody titers by day 7 post-vaccination,and higher levels at days 14 and 21.Notably,antibody levels in the experimental group were significant-ly higher than those in the control group(P＜0.000 1).These findings confirm that the double-gene-deletion strain S.equi subsp.equi ΔsagA/aroA exhibits reduced virulence while retaining im-munogenicity,which suggested it can be used as a promising candidate strain for further develop-ment of a live attenuated strangles vaccine.

Objective:To explore the feasibility of measuring the angle of progress(AOP)and the fetal head-perineum distance(HPD)by ultrasound to predict the duration of the second stage of labor.Methods:A to-tal of 135 full-term singleton primiparas who gave birth through vagina in Shandong Provincial Hospital Affiliated to Shandong First Medical University from September 2022 to June 2024 were selected.They all received medication for labor analgesia during labor,and the fetal position was determined as occipital anterior position by ultrasound when the cervix was fully dilated.AOP and HPD were measured during the contraction interval.All parturients were divided into group A(duration of the second stage of labor≤60 min),group B(60 min＜duration of the sec-ond stage of labor≤120 min)and group C(duration of the second stage of labor＞120 min).The differences of AOP and HPD among these groups were compared,and their predictive efficacy for vaginal delivery within 60min and 120min was evaluated.Results:①The AOP in group A was higher than that in group B.The HPD in group A was lower than that in group B.The differences were statistically significant(P＜0.01).The AOP in group B was higher than that in group C.The HPD in group B was lower than that in group C.The differences were statistically significant(P＜0.05).②The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 60 min was 0.872 and 0.914,and the optimal cut-off value was 126.25°and 4.52 cm,respectively(P＜0.01).③The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 120 min was 0.901 and 0.801,and the optimal cut-off value was 116.40°and 4.69 cm,respectively(P＜0.01).Conclusions:It is feasible to pre-dict the duration of the second stage of labor duration by measuring AOP and HPD using intrapartum ultrasound.

BACKGROUND:The definitive cause of adolescent idiopathic scoliosis is not yet known.The search for a clinical approach to address adolescent idiopathic scoliosis is imminent.OBJECTIVE:To investigate the effect of Schroth therapy combined with core strength training on mild adolescent idiopathic scoliosis and to provide more bases for the clinical treatment of mild adolescent idiopathic scoliosis.METHODS:110 patients with mild adolescent idiopathic scoliosis attending the Department of Rehabilitation Medicine and Department of Spine Surgery of Affiliated Hospital of Nantong University from July 2022 to January 2024 were selected as the study subjects.They were divided into the trial group and the control group according to the wishes of the patients and their parents,with 55 cases in each group.The control group was observed and followed up,and the trial group underwent Schroth therapy combined with core strength training for 45 minutes a day for 24 weeks.The differences in imaging parameters,body surface indexes,three-dimensional ultrasound imaging angle,and quality of life were compared between the two groups before and after treatment.RESULTS AND CONCLUSION:(1)At 24 weeks after treatment,major curve Cobb,apical vertebral translation,and cervical lordosis were significantly improved in the trial group(P＜0.05),while there was no significant difference in the control group(P＞0.05).Major curve Cobb and apical vertebral translation in the trial group were significantly better than those in the control group(P＜0.05).(2)At 24 weeks after treatment,angle of trunk rotation in the trial group was significantly lower than that before treatment(P＜0.05),while there was no significant difference between before and after treatment in the control group(P＞0.05),and angle of trunk rotation in the trial group was significantly lower than that of the control group(P＜0.05).(3)At 24 weeks after treatment,the center of laminae angle of three-dimensional ultrasound imaging was significantly reduced in the trial group(P＜0.05),while there was no significant difference in the control group before and after treatment(P＞0.05).The center of laminae angle of three-dimensional ultrasound imaging was smaller in the trial group than that in the control group(P＜0.05).(4)At 24 weeks after treatment,in terms of the quality of life,pain dimension score in the trial group was significantly increased(P＜0.05).Both trial and control groups showed significantly higher scores in the self-image dimension compared with that before treatment(P＜0.05).Both groups had significantly lower scores in the mental health dimension compared with that before treatment(P＜0.05).In the dimensions of pain,self-image,mental health,and satisfaction,the trial group was significantly higher than the control group(P＜0.05).(5)It is indicated that Schroth therapy combined with core strength training can improve the major curve Cobb,apical vertebral translation,and cervical lordosis angle,reduce the angle of trunk rotation,decrease the center of laminae angle of three-dimensional ultrasound imaging,and improve the quality of life,and it is effective in the treatment of mild adolescent idiopathic scoliosis.

Objective:To explore the application of BOPPPS(Bridge-in,Objective,Pre-assessment,Participatory Learning,Post-assessment,Summary)combined with Direct Observation of Procedural Skills(DOPS)in anesthesiology teaching under the background of medical-educational collaboration.Methods:A total of 60 students majoring in anesthesiology were selected as the research objects.A total of 30 students in grade 2018 were enrolled in the control group and receired traditional teaching mode.A total of 30 students in grade 2019 were enrolled in the research group and received BOPPPS teaching mode.The assessment of the internship after graduation for both groups adopted the DOPS assessment mode.Two groups of students were subject to pre-enrollment assessment,including process evaluations,such as theoretical class attendance,classroom interaction,pre-test scores,post-test scores,and the final theoretical test score.A comprehensive evaluation of teachers'teaching effect was conducted.When the two groups were discharged from the department,in addition to the assessment of professional theoretical knowledge of anesthesia and the operation of conventional anesthesia skills,they also underwent nine DOPS assessments.Results:There was no statistical difference between the two groups in the attendance(P＞0.05).The classroom interaction,pre-test scores,post-test scores,final test scores and total test scores in the study group were higher than those in the control group(P＜0.05).In terms of comprehensive evaluation of teaching effect,there was no statistical difference between the two groups in the evaluation of teachers'teaching attitude(P＞0.05).However,the research group reported higher satisfaction in teaching skills,methods,student-teacher interaction,and classroom engagement(P＜0.05).Both the theoretical and practical scores in the research group were higher than those in the control group(P＜0.05).The DOPS assessment results showed that the research group was superior to the control group in terms of indication mastery,operation completion,teamwork and problem-solving ability,and comprehensive ability performance(P＜0.05).Conclusion:The application effect of BOPPPS combined with DOPS in anesthesiology teaching is better than the conventional teaching mode.

Objective:To explore the feasibility of measuring the angle of progress(AOP)and the fetal head-perineum distance(HPD)by ultrasound to predict the duration of the second stage of labor.Methods:A to-tal of 135 full-term singleton primiparas who gave birth through vagina in Shandong Provincial Hospital Affiliated to Shandong First Medical University from September 2022 to June 2024 were selected.They all received medication for labor analgesia during labor,and the fetal position was determined as occipital anterior position by ultrasound when the cervix was fully dilated.AOP and HPD were measured during the contraction interval.All parturients were divided into group A(duration of the second stage of labor≤60 min),group B(60 min＜duration of the sec-ond stage of labor≤120 min)and group C(duration of the second stage of labor＞120 min).The differences of AOP and HPD among these groups were compared,and their predictive efficacy for vaginal delivery within 60min and 120min was evaluated.Results:①The AOP in group A was higher than that in group B.The HPD in group A was lower than that in group B.The differences were statistically significant(P＜0.01).The AOP in group B was higher than that in group C.The HPD in group B was lower than that in group C.The differences were statistically significant(P＜0.05).②The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 60 min was 0.872 and 0.914,and the optimal cut-off value was 126.25°and 4.52 cm,respectively(P＜0.01).③The area under the ROC curve for AOP and HPD to predict a vaginal delivery within 120 min was 0.901 and 0.801,and the optimal cut-off value was 116.40°and 4.69 cm,respectively(P＜0.01).Conclusions:It is feasible to pre-dict the duration of the second stage of labor duration by measuring AOP and HPD using intrapartum ultrasound.