Objective To assess the clinical value of multimodal ultrasound score for assessment of endometrial receptivity among patients with polycystic ovary syndrome (PCOS), and to provide guidance for improving pregnancy outcomes among PCOS patients. Methods A total of 48 PCOS patients admitted to Jiangning Hospital Affiliated to Nanjing Medical University between January and December 2023 were enrolled as the case group, while 50 healthy women of childbearing age received ovulation monitoring at the same hospital during the same period served as the control group. Subjects received two-dimensional grayscale ultrasound during the implantation window (19 to 23 days of the menstrual cycle) for measurement of endometrial thickness, Gonen classification, and endometrial peristalsis. Two-dimensional color Doppler ultrasound was used for assessment of endometrial blood flow and three-dimensional ultrasound was used for assessment of endometrial volume and vascularization flow index (VFI). The endometrium multimodal ultrasound scores were estimated, and various parameters were compared between the two groups. The diagnostic performance of these parameters for PCOS was evaluated with receiver operating characteristic (ROC) curves. Results The age of subjects in the case group ranged from 20 to 38 years, with a mean age of (28.20 ± 2.82) years, and their body mass index (BMI) ranged from 21.23 to 29.11 kg/m², with a mean BMI of (26.25 ± 1.60) kg/m². The age of subjects in the control group ranged from 22 to 38 years, with a mean age of (28.10 ± 1.99) years, and their BMI ranged from 21.33 to 29.03 kg/m², with a mean BMI of (26.10 ± 1.78) kg/m². There were no significant differences between the case and control groups in terms of mean age, BMI, estradiol, and testosterone (t = 0.218, 0.422, 0.010, and 0.221; all P > 0.05). The endometrial thickness, endometrial volume, and VFI were significantly higher in the control group than in the case group (t = 4.838, 4.978, and 7.115; all P < 0.05). There were significant differences between the two groups in terms of endometrial classification, endometrial peristalsis pattern, and endometrial and sub-endometrial blood flow (Z = −4.136, −4.048, and −3.884; all P < 0.05). The scores of endometrial classification, endometrial peristalsis, endometrial and sub-endometrial blood flow, endometrial volume, VFI, and multimodal ultrasound were significantly lower in the case group than in the control group (t = 4.539, 4.449, 4.205, 3.209, 5.206, and 4.495; all P < 0.05). No significant difference was detected in the endometrial thickness score between the two groups (t = -0.149, P = 0.882). The areas under the ROC curves for endometrial thickness, endometrial volume, VFI, and multimodal ultrasound scores in diagnosis of PCOS were 0.753, 0.747, 0.809, and 0.858, respectively. Conclusion Multimodal ultrasound score provides a comprehensive assessment of the endometrium, and is effective in the assessment of endometrial receptivity, which may provide a reference for guiding pregnancy planning in PCOS patients.

This article reported that clinical pharmacists participated in the anti-infection treatment process of a patient with fever after intracranial aneurysm operation.The initial fever in the patient caused by arachnoid hemorrhage was non-infectious fever.Then followed by intracranial infections,the intravenous regimen of vancomycin and meropenem was optimized according to clinically relevant guidelines and the blood-brain barrier permeability of antimicrobials.Later,Escherichia coli was reported via the cerebrospinal fluid culture,and the patient with intracranial infection was cured by step-down therapy with ceftazidime.During hospitalization,the patient experienced an adverse event of demyelinating myelitis,which was considered to be related to the excessive single dose of intrathecal gentamicin.The intrathecal administration was promptly discontinued,and eventually the patient recovered well in muscle power.Throughout the entire treatment process,clinical pharmacists assisted physicians in providing patient with an individualized treatment plan and provided reference for the safe,effective,and rational use of antibiotics.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective:To explore the current situation of the intrinsic capacity of elderly people in the community and analyze its influencing factors.Methods:From September 2022 to March 2023, convenience sampling was used to select 360 elderly community residents from Xicheng District, Beijing, and Xingtai City, Hebei Province, as the research subjects. The subjects were surveyed using the Intrinsic Capacity Assessment Questionnaire, Intrinsic Capacity Influencing Factors Questionnaire, Barthel Index, and Lawton Instrumental Activities of Daily Living Scale.Results:A total of 360 questionnaires were distributed, and 360 valid questionnaires were collected, with an effective response rate of 100.0% (360/360). The overall impairment rate of intrinsic capacity among 360 elderly people in the community was 90.3% (325/360), and the impairment rates in various fields from high to low were sensation, psychology, vitality, cognition, and exercise. Multiple linear regression analysis showed that age, gender, residential pattern, education level, work status, grip strength, number of geriatric syndrome, self-rated health status, adverse life events, number of social activities, transportation conditions, and social security were the influencing factors of the intrinsic capacity of elderly people in the community, and the difference was statistically significant ( P<0.05) . Conclusions:The impairment rate of intrinsic capacity among elderly people in the community is relatively high. Grassroots medical and nursing staff should assess the intrinsic capacity of elderly people in the community in health promotion work, identify elderly people with decreased intrinsic capacity early and carry out effective interventions to prevent elderly people from becoming disabled and dependent on care.

Objective:To systematically evaluate the real feelings and coping experiences of nursing students in geriatric nursing, so as to provide reference for nursing students to carry out geriatric nursing practice.Methods:Qualitative research on the geriatric nursing experience of nursing students was electronically searched in Chinese and English databases such as PubMed, Cochrane Library, Web of Science, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc. The search period was from database establishment to June 2023. The quality of the included literature was evaluated according to the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. The aggregation integration method was used to integrate literature results.Results:A total of 16 articles were included, and 41 results were extracted. The similar results were classified into eight categories and integrated into two integrated results, which were the challenges and obstacles faced by nursing students in the geriatric nursing process, as well as the experience of various complex emotions, and nursing students had a positive experience in the process of geriatric nursing, gaining personal growth and sublimation of values.Conclusions:Nursing educators should attach importance to the geriatric nursing experience of nursing students, pay attention to and guide their negative emotions and experiences, encourage nursing students to establish well interactive relationships with the elderly, and improve the comprehensive quality of geriatric nursing among nursing students through the design and implementation of emerging clinical teaching models.

Objective:To construct the training content system of aspiration prevention and management for ICU nurses, in order to improve the ability of ICU nurses in aspiration prevention and management, and provide a basis for nursing managers to carry out aspiration related training.Methods:This study preliminarily developed an item pool for the training content system of aspiration prevention and management through literature search and semi-structured interviews. From May to June 2023, the purposive sampling method was used to select 19 experts from Beijing, Shandong Province, Hubei Province and other places for two rounds of Delphi expert consultations, to determine the training content system for the prevention and management of aspiration among ICU nurses.Results:The effective response rates of the two-rounds of inquiry questionnaires were 95.5% (21/22) and 90.5% (19/21), respectively. The expert authority coefficients were 0.91 and 0.93, and the Kendall's harmony coefficients were 0.121 and 0.148 ( P<0.01). The final determination of the training content system for ICU nurse aspiration prevention and management included 10 primary indicators and 33 secondary indicators. Conclusions:The construction process of the training content system of aspiration prevention and management for ICU nurses is more scientific, reliable and full, which can guide the clinical practice of ICU nurses and provide reference for nursing managers to carry out education and training related to aspiration.

Objective:To provide evidence-based recommendations for the prevention and management of lower limb ischemia in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients during treatment according to search, evaluate, and summarize the best evidence on the prevention and management of lower limb ischemia in patients with VA-ECMO.Methods:Based on the PIPOST framework (population, intervention, professional, outcome, setting, and type of evidence), an evidence-based question was formulated. A systematic search was conducted according to the "6S" evidence pyramid model in both domestic and international databases, as well as professional association websites, for all evidence related to the prevention and management of lower limb ischemia in VA-ECMO patients (aged ≥18 years). The types of evidence included clinical decisions, guidelines, expert consensus, systematic reviews, evidence summaries, and original studies. The search was conducted from the construction of the databases to February 2024. Two researchers independently conducted a literature quality evaluation, extracted and summarized evidence from the studies that met the quality criteria.Results:A total of 13 articles were included, consisting of 3 clinical decisions, 3 guidelines, 3 expert consensus, 3 systematic reviews, and 1 randomized controlled trial. A total of 18 pieces of evidence in 7 dimensions were summarized, including risk factors of VA-ECMO lower limb ischemia, evaluation before catheterization, evaluation and monitoring during treatment, prevention of lower limb ischemia, treatment of lower limb ischemia, management of distal perfusion catheter (DPC), and monitoring after VA-ECMO weaning.Conclusion:This evidence summary provides evidence-based recommendations for the prevention and management of lower limb ischemia in VA-ECMO patients, aiming to assist clinical healthcare professionals in developing tailored strategies for the prevention and management of lower limb ischemia based on during VA-ECMO support.

Objective By comparing with arthroscopic rotator cuff repair alone,to explore the efficacy and difference of leukocyte poor platelet-rich plasma(LP-PRP)and leukocyte rich platelet-rich plasma(LR-PRP)in arthroscopic rotator cuff repair.Methods Sixty patients with total rotator cuff tear accompanied by arthroscopic rotator cuff repair admitted to the Affiliated Hospital of North China University of Science and Technology from October 2021 to September 2022 were included and randomly divided into control group(n=20),LP-PRP group(n=20)and LR-PRP group(n=20).The control group only received arthroscopic rotator cuff repair.The LP-PRP group was injected with leukocyte poor platelet-rich plasma(LP-PRP)into the sutured torn tendon after the same operation,and the LR-PRP group was injected with leukocyte rich platelet-rich plasma(LR-PRP)into the sutured torn tendon after the same operation.The postoperative rehabilitation training plan of the three groups was the same,and the postoperative follow-up and evaluation were conducted for 1 year.It included pain score(VAS score),shoulder joint function score(CMS,UCLA,ASES score),retear rate and related complications.Results All patients were followed up.(1)VAS score:Compared with the LR-PRP group and the control group,the results were statistically significant only at 1,3 and 6 weeks after surgery(P<0.05);There was no statistical significance between the LR-PRP group and the control group at 1 week,3 weeks,6 weeks,3 months,6 months and 12 months after surgery(P>0.05).(2)CMS,UCLA and ASES scores:There were no significant differences between the LP-PRP group and the LR-PRP group at 3 months,6 months and 12 months after surgery(P>0.05);Compared with LP-PRP group and LR-PRP group,there were significant differences in each follow-up time point of control group(P<0.05).(3)Retear rate:In the LP-PRP group,there was 1 retear in the LR-PRP group(tear rate 5%),and 3 in the control group(tear rate 15%).There was no statistically significant difference between the three groups(P>0.05).(4)There were no postoperative complications in 60 patients.Conclusions Compared with arthroscopic rotator cuff repair alone,although the application of LP-PRP and LR-PRP could not reduce the rate of retear,it could significantly improve the shoulder joint function of patients,and LP-PRP could significantly reduce the pain of patients with rotator cuff injury in the early postoperative period(within 6 weeks),with no postoperative complications,and the short-term clinical results of patients were satisfactory.

Objective:To study the standardization path of medical ultrasound equipment management based on total quality management,and to improve the service level of medical ultrasound equipment in clinical diagnosis and treatment activities.Methods:According to the process of medical ultrasound equipment use,the risk nodes were determined,the formation path and damage probability of equipment use risk were analyzed by probabilistic graphical model,and the standardized path of medical ultrasound equipment use was formulated based on time control and standardized use mode.35 medical ultrasound equipment in clinical use in The People's Hospital of Jianyang from 2022 to 2023 were selected,the use and management of 33 medical ultrasound equipment in 2022 were managed in the conventional management mode(33 units),and the use and management of 35 medical ultrasound equipment in 2023(2 new units)were adopted in the total quality management mode.The difference in equipment operation quality,risk ratio and service effect under different modes were compared.Results:The failure rates of medical ultrasound diagnostic equipment,medical ultrasound treatment equipment and other medical ultrasound equipment using the total quality management model were(0.763±0.68)%,(0.833±0.65)%and(0.969±0.64)%,respectively,which were lower than those of the conventional management mode,the difference was statistically significant(t=3.331,5.348,5.940,P<0.05).The proportion of risk problems such as component damage,delayed diagnosis and treatment,resource waste and social impact of medical ultrasound equipment using total quality management mode were(2.023±0.99)‰,(1.569±0.89)‰,(2.541±1.05)‰ and(1.238±0.63)‰,respectively,which were lower than those of the conventional management mode,the difference was statistically significant(t=3.935,3.676,5.699,3.189,P<0.05).The scores of clinicians,nurses,operating technicians,equipment engineers and management personnel involved in the use and management of medical ultrasound equipment were for the service effect of the total quality management model were(95.797±2.13)points,(93.880±2.12)points,(94.605±1.91)points,(91.387±3.20)points and(96.275±1.82)points,respectively,which were higher than those of the conventional management mode,the difference was statistically significant(t=4.536,5.477,6.869,2.943,4.673,P<0.05).Conclusion:The standardized path of medical ultrasound equipment management based on total quality management can improve the operation quality of equipment,reduce the incidence of clinical use risk,and enhance the level of clinical service.

Objective:To investigate the effects of tetrabromobisphenol A (TBBPA) on ionizing radiation (IR)-induced liver toxicity based on a zebrafish model and provide a scientific basis for assessing microplastic-radiation exposure hazards to the survival and health of aquatic organisms and humans.Methods:Healthy adult zebrafish aged 4-6 months were grouped (20 fish each group, sex in half) by random number table method in three different ways. The TBBPA exposure concentration screening experiment was divided into 4 groups: control group and TBBPA (3, 30 and 300 μg/L) treatment groups. The experiment of effects of double exposure on liver function was divided into 5 groups: control group, IR (10, 20 or 30 Gy) groups and IR+ TBBPA (60, 300 and 1 500 μg/L) treatment groups. The experiment of effects of TBBPA on hepatic radiation toxicity was divided into 3 groups: control group, IR (20 Gy) group, and IR+ TBBPA (300 μg/L) group. The changes in liver function indexes, oxidative stress markers, pro-inflammatory cytokines, and liver cell apoptosis were monitored, differential metabolic pathways and metabolites were identified upon untargeted metabolomics assays, and inter-group data were compared by One-way ANOVA test.Results:The activities of ALT and AST in zebrafish liver increased in a dose-dependent manner after exposure to TBBPA, and the differences between 300 μg/L TBBPA group and control group were statistically significant ( t=-2.22, -3.20, P<0.05). IR at a dose of 20 Gy or above induced a significant decline of liver function, and at this radiation dose, combined exposure to 300 μg/L or above TBBPA intensified the liver toxicity (compared with the control group, t=-8.18 to -4.63, P<0.05, compared with IR group, t=-5.22 to -0.30, P < 0.05). Compared with the control group, the activities of ALT and AST, levels of ROS, MDA and SOD, mRNA and protein expression levels of TNF-α, IL-1β, Cox-2, Caspase-8 and Caspase-9, and cell apoptosis in zebrafish livers of IR and IR+ TBBPA groups increased gradually (compared with the control group, t=-12.29 to -2.88, P<0.05, compared with IR group, t=-4.40 to -2.31, P<0.05). The differences in the content of D-gluconic acid, p-cresol and other metabolites in liver tissues were more and more significant among the three groups, involving multiple KEGG pathways such as biosynthesis, degradation and metabolism. Conclusions:Exposure to 300 μg/L TBBPA can aggravate IR-induced liver toxicity of zebrafish, which involves the mechanism that further elevates the levels of oxidative stress, inflammation, and apoptosis, as well as radiation-induced liver metabolic disorders.