Cognitive dysfunction is a common complication of diabetes mellitus(DM)with a complex pathogenesis that may be closely related to neuropathic changes.Functional magnetic resonance imaging(fMRI)can investigate brain function by measuring changes in brain tissue structure and hemodynamics following enhanced neural activity,potentially facilitating early detection of the brain pathophysiological changes underlying cognitive dysfunction in DM.This paper reviews the application of fMRI technology in the assessment of brain structure and function in diabetic patients,aiming to provide a basis for the early detection,intervention,and research on cognitive impairment in DM.

Cognitive dysfunction is a common complication of diabetes mellitus(DM)with a complex pathogenesis that may be closely related to neuropathic changes.Functional magnetic resonance imaging(fMRI)can investigate brain function by measuring changes in brain tissue structure and hemodynamics following enhanced neural activity,potentially facilitating early detection of the brain pathophysiological changes underlying cognitive dysfunction in DM.This paper reviews the application of fMRI technology in the assessment of brain structure and function in diabetic patients,aiming to provide a basis for the early detection,intervention,and research on cognitive impairment in DM.

Objective:To explore the clinical efficacy of anterolateral thigh perforator flap (ALTPF) in treatment of extensive wound of Degree IV burns in limbs.Methods:A retrospective analysis was conducted on 9 patients who had extensive wound of Degree IV burns in limbs caused by stove burns admitted to Department of Burns and Plastic Surgery, the 988th Hospital of the Joint Logistics Support Force of the Chinese PLA between January 2017 and January 2024. Among the patients, there were 8 males and 1 female, aged between 36 and 63 years. Three patients had the wound from anterior leg to dorsal foot, 3 from leg down to ankle, 1 from forearm to hand and 2 from arm to forearm. Area of burns ranged from 20 cm × 15 cm to 30 cm × 25 cm, and all patients were treated by free ALTPF. According to whether the main artery at the recipient site was feasible for direct anastomosis with the vessels carried in flap, 4 patients were treated by bilateral parallel ALTPFs, and 5 were treated by unilateral ultra-long internally supercharged ALTPF. A total of 13 ALTPFs were harvested, with individual flap size at 20 cm × 8 cm to 46 cm × 12 cm. Donor sites were directly sutured. Time for flap harvesting, flap survival and wound healing time were records. Scheduled postoperative follow-up was conducted at outpatient clinic and via telephone interviews to evaluate functional recovery. Follow-up assessments included evaluation of flap condition, two-point discrimination (TPD), recovery of joint function at recipient sites, flap appearance and donor site recovery.Results:The time for flap harvest was 1.0 to 4.5 hours. All 13 ALTPFs successfully survived. The time from surgery to healing of recipient sites was 18 to 72 days, and all donor sites healed. Over the postoperative follow-up that lasted for 6 to 34 months, the recipient sites had found with good cosmetic outcomes, without osteomyelitis or deep tissue infection. Four ALTPFs in 2 patients were found swelling, which were revised at 6 months after surgery. Four ALTPFs in other 2 patients had pigment deposition at edges. One ALTPF was scalded, which healed after dressing changes but left with patchy scars. The remaining ALTPFs were soft, elastic, free from pain and well-perfused, with regained protective sensation at S 3. However, all of the ALTPFs failed to detect TPD. Six patients with lower limb injuries were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scoring system: 2 patients were rated as excellent and 4 were rated as good. Three patients with upper limb injuries were evaluated using Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association: 1 patient was rated as excellent and 2 were rated as good. Only linear scars left at the 13 donor sites, with normal blood supply to the distal limbs, and without restrictions in range of motion of knee joints nor muscle strength of quadriceps. Conclusion:The ALTPF offers advantages such as anatomical consistency, reliable blood supply and flexible combination in treatment of extensive wound of Degree Ⅳ burns in limbs. It is an ideal surgical procedure for treatment of large soft tissue defects of extremities.

Objective:To explore the clinical efficacy of anterolateral thigh perforator flap (ALTPF) in treatment of extensive wound of Degree IV burns in limbs.Methods:A retrospective analysis was conducted on 9 patients who had extensive wound of Degree IV burns in limbs caused by stove burns admitted to Department of Burns and Plastic Surgery, the 988th Hospital of the Joint Logistics Support Force of the Chinese PLA between January 2017 and January 2024. Among the patients, there were 8 males and 1 female, aged between 36 and 63 years. Three patients had the wound from anterior leg to dorsal foot, 3 from leg down to ankle, 1 from forearm to hand and 2 from arm to forearm. Area of burns ranged from 20 cm × 15 cm to 30 cm × 25 cm, and all patients were treated by free ALTPF. According to whether the main artery at the recipient site was feasible for direct anastomosis with the vessels carried in flap, 4 patients were treated by bilateral parallel ALTPFs, and 5 were treated by unilateral ultra-long internally supercharged ALTPF. A total of 13 ALTPFs were harvested, with individual flap size at 20 cm × 8 cm to 46 cm × 12 cm. Donor sites were directly sutured. Time for flap harvesting, flap survival and wound healing time were records. Scheduled postoperative follow-up was conducted at outpatient clinic and via telephone interviews to evaluate functional recovery. Follow-up assessments included evaluation of flap condition, two-point discrimination (TPD), recovery of joint function at recipient sites, flap appearance and donor site recovery.Results:The time for flap harvest was 1.0 to 4.5 hours. All 13 ALTPFs successfully survived. The time from surgery to healing of recipient sites was 18 to 72 days, and all donor sites healed. Over the postoperative follow-up that lasted for 6 to 34 months, the recipient sites had found with good cosmetic outcomes, without osteomyelitis or deep tissue infection. Four ALTPFs in 2 patients were found swelling, which were revised at 6 months after surgery. Four ALTPFs in other 2 patients had pigment deposition at edges. One ALTPF was scalded, which healed after dressing changes but left with patchy scars. The remaining ALTPFs were soft, elastic, free from pain and well-perfused, with regained protective sensation at S 3. However, all of the ALTPFs failed to detect TPD. Six patients with lower limb injuries were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scoring system: 2 patients were rated as excellent and 4 were rated as good. Three patients with upper limb injuries were evaluated using Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association: 1 patient was rated as excellent and 2 were rated as good. Only linear scars left at the 13 donor sites, with normal blood supply to the distal limbs, and without restrictions in range of motion of knee joints nor muscle strength of quadriceps. Conclusion:The ALTPF offers advantages such as anatomical consistency, reliable blood supply and flexible combination in treatment of extensive wound of Degree Ⅳ burns in limbs. It is an ideal surgical procedure for treatment of large soft tissue defects of extremities.

【Objective:】 To construct a palliative care training course for medical student volunteers, so as to provide reference for palliative care institutions to carry out palliative care training for medical student volunteers. 【Methods:】 Based on literature review, semi-structured interviews and the expert group meeting method, the first draft of the palliative care training course for medical student volunteers was drawn up. Then two rounds of expert consultation with 16 experts in relevant fields by Delphi method was conducted. 【Results:】 The positive coefficients of the two rounds of expert consultation were 89% and 100%, respectively. The expert authority coefficients of the two rounds were both 0.89. The Kendall coefficient of the second round was 0.196 to 0.328 (P<0.05). The final form of palliative care training course for medical student volunteers was consisted of 5 primary indicators (training objective, training content, training hour, training method, and assessment method), 23 secondary indicators, and 41 tertiary indicators. 【Conclusion:】 The palliative care training course for medical student volunteers is comprehensive and practical in content, scientific and reliable in construction, which can be used for hospice care institutions to provide palliative care volunteer service training for medical student volunteers, in order to improve the quality of volunteer service.

Objective:To test the reliability and validity of the Chinese version of the Demoralization Scale-Ⅱ (DS-Ⅱ) in maintenance hemodialysis (MHD) patients.Methods:This was a cross-sectional study. From October 2021 to February 2022, 989 patients who received MHD in 16 hospitals in Xiangyang City, Hubei Province, were selected by convenience sampling as the study subject. The patients were investigated with the General Information Questionnaire, DS-Ⅱ, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) . The correlation coefficient and critical ratio were used for project analysis. The reliability of the total scale and sub-scale were tested by Cronbach 's α coefficient, split half reliability coefficient, retest reliability coefficient. The exploratory factor analysis was used to determine item pool dimension and scale structure, and the confirmatory factor analysis was used to test the structural validity of the scale. We tested the correlation among the scores of SAS, SDS and Chinese version of DS-Ⅱ. A total of 989 questionnaires were distributed, and 920 valid questionnaires were recovered, with a valid recovery rate of 93.02% (920/989) . Results:The correlation coefficient among each item score and the total score of the scale was 0.679 to 0.777 ( P<0.05) . The critical ratio of each item in high score group and low score group was 21.637 to 30.719 ( P<0.05) . The total content validity coefficient of the scale was 0.984, and the content validity coefficient of each item was 0.875 to 1.000. Two common factors were extracted after exploratory factor analysis, and the cumulative variance contribution rate was 59.844%. The confirmatory factor analysis showed that the model fitted well, and the correlation coefficients among items and dimensions were 0.687 to 0.803. The total score of DS-Ⅱ and each factor score were positively correlated with scores of SAS and SDS ( P<0.05) . Cronbach 's α coefficient of the total scale was 0.944, and the split half reliability Guttman 's coefficient was 0.884, and the retest reliability coefficient was 0.909. Conclusions:The Chinese version of DS-Ⅱ has good reliability and validity in MHD patients.

Objective:To translate and culturally adjust Decisional Fatigue Scale (DFS) , and test its reliability and validity.Methods:The Chinese version of DFS was formed through the method of double translation, back translation and expert consultation. Using the convenient sampling method, 247 medical staffs from 16 departments in 76 wards of Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine were selected as the research objects. Content validity, criterion validity and structure validity were used for validity evaluation, and internal consistency reliability, split half reliability and retest reliability were used for reliability evaluation. A total of 247 questionnaires were sent out in this study and 247 were effectively received, with effective recovery of 100.00%.Results:The total Cronbach's α coefficient of Chinese DFS was 0.933, the half-reliability coefficient was 0.849 and the retest reliability coefficient was 0.838 ( P<0.01) . Both the item content validity index and scale content validity index were 1.00, and the correlation coefficient with the total score of SRF-S was 0.729 ( P<0.01) . One common factor was extracted by exploratory factor analysis and 65.64% of the variation was explained cumulatively, which was consistent with the dimensions of the original scale. Confirmatory factor analysis showed that all fitting indexes were up to standard and the fitting degree was good. Conclusions:The reliability and validity of the Chinese version of DFS in medical staffs is good, which can be used to evaluate the degree of decision-making fatigue of Chinese medical staffs.

Objective:To investigate the cognition and attitude of nephrology nurse to palliative care for patients with end-stage renal disease, and to provide reference for the promotion and application of palliative care in patients with end-stage renal disease.Methods:Using the phenomenological research method, the purpose sampling method and the principle of data saturation, the semi-structured interviews were conducted among 12 nurses from the Department of Nephrology in Xiang Yang NO.1 People ′s Hospital, Hubei University of Medicine in November 2021. The data were analyzed, summarized and extracted by Colaizzi 7-step analysis method. Results:The cognition and attitude of nephrology nurses to palliative care of patients with end-stage renal disease were summarized into three themes. They were: different cognition of palliative care; attitudes towards palliative care for end-stage renal disease patients (positive feelings, negative feelings); difficulties in the implementation of palliative care (difficult decision-making, unknown timing and effect, lack of social policy support, traditional thought constraints).Conclusions:Interviewees lacked cognition to palliative care and have different attitudes. In order to promote the application of palliative care in patients with end-stage renal disease, relevant publicity and education should be strengthened, the palliative care system of end-stage renal disease should be improved, and social support for palliative care should be enhanced.

Objective:To explore a surgical technique and treatment outcomes of the segmentle bridging reconstruction for severed fingers with single segmentle defect by using the free second toe bone-joint composite tissue combined with the great toe flap.Methods:From June 2010 to September 2017, 5 patients suffered from severed segmental defect of finger were treated. According to the defects of bone-joints, blood vessels, nerves, tendons and other soft tissues, the reconstruction surgery was designed to create a Flow-through bridging composite flap pedicled with the first dorsal metatarsal artery or the plantar artery. The blood vessles carried by the pedicle were anastomosed with the vessels in the finger to restore the blood supply to the distal finger while having the defected finger segment reconstructed. A Flow-through bridging composite flap was created by taking the second toe bone-joint composite tissue combined with a C-shaped or half-moon shaped flap from the fibular side of the great toe. Skin graft, retrograde lateral tarsal flap or free perforator flaps were used in 3 cases to repair the donor sites of the great and second toes. Iliac strip was implanted in 2 cases for toe salvage. Kirschner wires were removed 4-6 weeks after surgery followed by functional exercise.Results:All of the 5 reconstructed distal segments of the fingers survived with the healing of fractures in 8-12 week after surgery. The postoperative follow-up lasted 6-36 months and all the patients had the follow-ups at the outpatient clinic. It was found that the maximum flexion of the reconstructed interphalangel joint was 60 degrees together with dorsiflezion. According to the evaluation standard of the reconstructed function for thumb and finger issued by the Hand Surgery Society of the Chinese Medical Association, 3 fingers were in excellent and 2 in good. No obviouse affect on walking was found in all the patients.Conclusion:The free second toe joint composite tissue together with the great toe flap can be used to bridge the single segmental defect of a finger. It restores the blood supply to as well as the appearance of the distal finger, helps the recovery of the reconstructed distal finger. It is an ideal technique in the treatment of a severed distal segment of the finger.

Objective:To investigate the efficacy of the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery to repair the composite tissue defect in the Achilles tendon area.Methods:From January 2016 to June 2021, 12 patients suffering from infectious wound with defect of Achilles tendon were treated in the Department of Trauma and Microscopic Orthopaedics, 988th Hospital of the Joint Logistics Support Force of PLA. The area of soft tissue defect around Achilles tendon was 2.5 cm× 4.5 cm-8.0 cm×12.5 cm, and the length of the defect of Achilles tendon was 3.0-7.0 cm. The defect around the Achilles tendon were repaired with the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric Achilles tendon flap (ATF) and the posterior perforating branch of peroneal artery was used as the vessel of blood supply. The size of flap was 3.0 cm×5.0 cm-9.0 cm×13.0 cm, and the size of the ATF was 3.0 cm×4.0 cm-3.0 cm×8.0 cm. The donor sites were sutured directly (8 cases) or repaired with skin graft (4 cases). External fixation were put on for 6 weeks after surgery. Then the external fixation was removed and the functional exercise gradually started. Outpatient clinic follow-ups were carried out regularly. Thermann Achilles tendon function assessment system was used to evaluate the last follow-up.Results:The chimeric ATF was harvested and the blood supply of each flap was good during the operation. There was no vascular crisis after surgery. The flaps survived smoothly and the wound achieved grade A healing. All patients were entered follow-up that lasted for 10-24 months. There was good appearance of flaps with minor bloating, and the colour of flaps was similar to the skin around the receiving site. The texture was soft with normal function of the lower legs and ankle. Tendon function was evaluated by Thermann Achilles tendon function assessment system, the result were 8 cases in excellent and 4 cases in good.Conclusion:The nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery can accurately repair a composite tissue defect in the Achilles tendon area, and it is one of the effective methods for the repair of a composite soft tissue wound with Achilles tendon defect.