OBJECTIVE To develop a questionnaire of the Knowledge-Attitude-Practice （KAP） for patients receiving oral anticoagulant therapy. METHODS Under the guidance of the theory of KAP， literature analysis and interview method were used to design the initial KAP questionnaire for patients treated with oral anticoagulants. Delphi method was adopted to consult the initial questionnaire and modify the questionnaire based on expert suggestions to form the final questionnaire. RESULTS Two rounds of consultation were conducted with 18 experts， and 18 questionnaires were sent out and recovered in each round， so the positive coefficient of experts was 100%. The expert authority coefficient was 0.94. The average importance scores for all dimensions， factors， and items of the questionnaire in both rounds were ≥4 points. The coefficient of variation was ≤0.25. The Kendall’s concordance coefficient for the overall questionnaire and the three dimensions of knowledge， attitude， and practice ranged from 0.09 to 0.34 （all P＜0.05）. Following the first round of expert consultation， four items were modified， two items were deleted， and five items were added； after the second round of expert consultation， ten items were modified. The final version of the questionnaire included three dimensions （knowledge， attitudes， and practice）， 17 questionnaire factors， and 40 items. CONCLUSIONS The questionnaire has high reliability and scientific validity with relatively concentrated expert opinions. It is suitable for assessing the knowledge， attitudes， and practice status of patients receiving oral anticoagulant therapy.

Objective To analyze the content and psychometric properties of measurement tools for children's gross motor function and activity. Methods Six measurement tools for children's gross motor function and activity were selected,including Gross Motor Function Measure(GMFM),Bruininks-Oseretsky Test of Motor Proficiency-Second Edition(BOT-2),Peabody Developmental Motor Scales-Second Edition(PDMS-2),Movement Assessment Battery for Children-Second Edition(MABC-2),Test of Gross Motor Development-Third Edition(TGMD-3)and Functional Movement Screen(FMS).International Classification of Functioning,Disability,and Health(ICF)linking rules,categories and coding were used to analyze the content of measurement dimensions and items of these six tools,and their psychometric properties were explored. Results For the body function,the content of these six tools primarily addressed neuromusculoskeletal and movement-re-lated functions(b7),such as mobility of joint functions(b710),stability of joint functions(b715),muscle power functions(b730),motor reflexes functions(b750),control of voluntary movement functions(b760),supportive functions of arm or leg(b7603)and gait patterns functions(b770).For the activities and participation,the content primarily addressed mobility(d4),such as changing and maintaining body positions(d410,d415),transferring oneself(d420),walking(d450),running(d4552),and jumping(d4553).GMFM was good in inter-rater and test-retest reliability;BOT-2 was good in inter-rater reliability,test-retest reliability and internal consistency;PDMS-2 was good in inter-rater and test-retest reliability;MABC-2 was good in test-retest reliability and internal consis-tency with an excellent model fit;TGMD-3 was good in internal consistency and test-retest reliability;and FMS was good in internal consistency and test-retest reliability. Conclusion The six tools for motor and activity function measurement primarily concern neuro-musculoskeletal and movement-related functions(b7)for ICF body function,and mobility(d4)for activities and participation.PDMS-2 is suggested for a comprehensive evaluation of children's motor functions and activities;TGMD-3 and GMFM for gross motor functions;and BOT-2,MABC-2 and FMS for motor development,coordination and functional movement patterns.BOT-2,PDMS-2,MABC-2 and TGMD-3 are norm-referenced measures,whereas GMFM and FMS are criterion-referenced.Norm-referenced tools,due to their established norms tailored for various ob-jectives,boast superior psychometric properties and wider applications.All the six tools exhibit good to excellent reliability,and internal consistency coefficients ranging from moderate to excellent.Their validity also spans from moderate to excellent.

Objective:To investigate the image quality, radiation dose, and diagnostic efficiency of the regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, in the assessment of coronary in-stent restenosis.Methods:A total of 120 patients (with 142 stents) treated with coronary stent implantation at the Beijing Renhe Hospital from August 2020 to August 2022 were enrolled in this study. They were randomly divided into an observation group (60 cases with 70 stents) and a conventional group (60 cases with 72 stents) using the random number table method. Both groups received GE 256-slice Revolution CT examinations. Patients in the conventional group were injected with 70 ml of iopromide as a contrast agent each, while those in the observation group were given individualized doses based on their body mass indices (BMIs). A tube voltage of 120 kV and a tube current of 534 mA were applied to the conventional group, whereas the tube voltage and current for the observation group were adjusted within the ranges of 80-120 kV and 150-534 mAs based on patients’ BMIs. Both groups received coronary angiography 7-14 d after coronary computed tomography angiography (CCTA). Finally, the CT image quality, radiation dose, iodine intake, and diagnostic efficiency were compared between the two groups.Results:Both groups exhibited no significant differences in CT values, contrast-to-noise ratios, blooming artifacts, and stent diameters of the left main coronary artery ( P > 0.05). The conventional group manifested higher CT dose index, CT dose length product, effective dose, and iodine intake compared to the observation group ( t = 10.30, 8.75, 10.27, 4.60, P < 0.05). With coronary angiography result as the gold standard, the observation and conventional groups yielded Kappa values of 0.904 and 0.879, respectively, suggesting high consistency in diagnostic performance. Additionally, the two groups demonstrated nonsignificant differences in sensitivity and specificity ( P > 0.05). Conclusions:The regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, yielding image quality and diagnostic efficiency equivalent to those of the conventional regimen, can effectively reduce radiation dose and iodine intake. Therefore, this regimen merits wide applicability.

Objective:To investigate the effectiveness of the S-PAL model (combining a student standardized patient with peer assisted learning) in experimental teaching of physical diagnostics.Methods:Eighty-four undergraduate students of grade 2022 in clinical medicine of Chongqing Medical University were divided into experimental group ( n=44, experimental class teaching combined with S-PAL model-based autonomous practice) and control group ( n=40, experimental class teaching combined with traditional autonomous practice). Performance evaluation and teaching feedback and satisfaction survey were conducted. SPSS 27.0 was used to perform the t-test, chi-square test, and Fisher's exact test. Results:There were no significant differences between the two groups in terms of age, sex, the grade point average, and pre-training theoretical scores. The academic assessment score of the experimental group (66.34±15.45) was significantly higher than that of the control group (55.12±15.02). The experimental group was superior to the control group in clinical skills assessed with the mini-clinical evaluation exercise. The experimental group had a higher degree of satisfaction with teaching than the control group. The experimental group highly accepted autonomous practice based on the S-PAL model.Conclusions:The S-PAL model can improve medical undergraduates' academic performance and satisfaction with teaching in physical diagnostics, and also promote their doctor-patient communication skills, which is a good self-learning model as a complement to physical diagnostics teaching.

Objective To analyze the potential categories of foot care knowledge-attitude-practice(KAP)of diabetic high-risk foot patients,and analyze the influencing factors of different potential categories classification prediction,so as to provide references for clinical nursing.Methods By convenience sampling,a questionnaire survey was conducted from July to December 2023,employing a general information questionnaire and a diabetes foot care KAP evaluation scale on patients at high risk of diabetic foot in a tertiary hospital in Guangzhou.Latent profile analysis was used to identify the potential classifications of foot care KAP status among these patients.The iterative dichotomiser 3 algorithm of decision tree in machine learning was used to make classification prediction of foot nursing KAP status of patients,using multivariate logistic regression to analyse its influencing factors.Results There are 3 potential profiles of foot care KAP in high-risk diabetic foot patients,including"high knowledge-medium attitude-medium behavior"type(29.00％),"low knowledge-low attitude-low behavior"type(56.00％)and"medium knowledge-high attitude-high practice"type(15.00％).Decision tree model showed that residence,education level,receiving education about diabetic foot and stage of diabetic high-risk foot were decision-making factors for different potential categories of foot care KAP.The results of the Logistic analysis showed that literacy level,per capita monthly household income,and whether received diabetes-related follow-up were influential factors in different potential profiles of foot care KAP.Conclusion The level of foot care KAP of patients at high risk of diabetic foot needs to be improved,and shows population heterogeneity.Medical staff should intervene and support diabetic foot patients at high risk according to different potential profile and influencing factors to improve their KAP level.

ObjectiveTo systematically analyze the content and health benefits of structured physical activity programs for children with autism spectrum disorders (ASD). MethodsPublished literature related to structured physical activity for children with ASD and its health benefits were searched in Wanfang database, CNKI, Embase, EBSCO and PubMed from January, 2013 to July, 2023. A systematic review was conducted using the PRISMA guidelines. ResultsSeven literatures were finally included, from China, USA, Germany, Italy and Turkey. The publication dates concentrated after 2019. The study designs were all randomised controlled trials with 193 children with ASD, aged three to 14 years. Structured physical activity intervention sites included community sports halls, special education schools, rehabilitation wards of children's hospitals, and rehabilitation centers for children with disabilities. The intervention attributes were generally treatment, rehabilitation and health promotion. The content of physical activity mainly included motor skill-based activities (e.g., running, jumping, kicking, hitting, throwing), traditional yoga activities (e.g., breathing, mimicking postures and relaxation, as well as appropriate socialization activities such as encouragement of greeting/farewell songs, touch/contact games and expressive games), and a combination of multiple types of exercises integrated with school-based curricula such as aerobic exercises (walking), endurance exercises (jumping) and neuromuscular exercises (throwing paper airplanes), mindfulness for emotions and body, and judo. The frequency of the intervention ranged from 40 to 90 minutes, one to four times a week; the intensity ranged from mild to vigorous; and the duration ranged from eight to 40 weeks. The physical and behavioral health benefits were reflected in three aspects. In terms of body composition, it could reduce fat and body mass, increase muscle strength, and improve cardiorespiratory function. In terms of function, it could improve children's language and communication function, cognitive and executive function, and motor function. In terms of physical activity-related health behaviors, it could enhance children's motivation to exercise, reduce sedentary behavior, increase social and interactive behavior, improve emotional regulation, and reduce the risk of problematic behaviors. ConclusionThe physical and behavioral health benefits of structured physical activity for children with ASD can be reflected in the areas of body composition, function, and physical activity-related health behaviors.

ObjectiveTo explore the effects of different intensity of wearable lower limb rehabilitation robot-assisted training on walking function, lower limb motor function, balance function and functional independence of stroke patients. MethodsFrom November, 2021 to December, 2022, 60 stroke patients hospitalized in Beijing Bo'ai Hospital were randomly divided into control group (n = 20), observation group 1 (n = 20) and observation group 2 (n = 20). All the groups received routine rehabilitation, while the control group received routine walking training 30 minutes a day, the observation group 1 received wearable lower limb rehabilitation robot-assisted training 30 minutes a day, and the observation group 2 received wearable lower limb rehabilitation robot-assisted training 60 minutes a day, for four weeks. They were assessed with Functional Ambulation Category scale (FAC), Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Berg Balance Scale (BBS) and Rivermead Mobility Index (RMI) before and after treatment. ResultsOne case in the observation group 1 and three cases in the observation group 2 dropped down. The FAC, FMA-LE, BBS and RMI scores improved in all the three groups after treatment (|Z| > 3.448, |t| > 8.102, P < 0.001), and there was no significant difference in all the indexes among the three groups (|H| < 4.643, F = 1.454, P > 0.05); however, the improvement of BBS score was more in the observation group 1 than in the control group (P < 0.05), and the improvement of all the indexes was more in the observation group 2 than in the control group (P < 0.05). ConclusionThe wearable lower limb rehabilitation robot-assisted training may promote the recovery of walking function, lower limb motor function, balance function and functional independence of stroke patients, and high-intensity training seems to be more effective.

Objective To establish an improved type Ⅱ cardio-renal syndrome rat model and evaluate it.Methods Twenty male SD rats were randomly divided into sham and model groups with 7 rats in the sham group and 13 rats in the model group.The model group received the method of squeezing the heart under a small animal anesthesia machine to permanently ligate the left anterior descending branch of the coronary artery to cause myocardial infarction.One week later,unilateral nephrectomy(right nephrectomy)was performed.The rats underwent cardiac echocardiography,pathological staining,and blood and urine tests at 6 weeks to verify model establishment.Results Compared with the sham group,the cardiac function assessed by echocardiography and the endogenous creatinine clearance rate in the model group rats were significantly decreased(P<0.01),and the levels of brain natriuretic peptide,blood creatinine,urea nitrogen,and 24 h urine protein in the model group were significantly increased(P<0.01).HE staining revealed a disordered myocardial arrangement,glomerular atrophy,and inflammatory cell infiltration in model group rats.Picric acid-Sirius red staining showed a significant increase in myocardial collagen fibers,an irregular arrangement of renal tubules,and a large amount of collagen deposition in model group rats.The positive staining area ratio was also significantly increased(P<0.01).Conclusions This improved modeling method provided a typeⅡcardio-renal syndrome rat model with s simple operation,minimal surgical trauma,and low mortality rate.This model simulates the early onset of cardiac and renal function damage and pathological changes in type Ⅱ CRS,laying the foundation for systematic and in-depth research on the pathogenesis and pathological mechanism of type Ⅱ cardio-renal syndrome.

AIM: To observe the clinical efficacy of Fuzheng Xiaoliu Granules in the treatment of stage II primary liver cancer and to explore its mechanism of action from the perspective of metabolomics. METHODS: Sixty patients with stage II primary liver cancer who achieved complete remission (CR) after comprehensive interventional therapy were randomly divided into treatment group and placebo group, with 30 patients in each group. They were treated for one year and observed for one year. The one-year recurrence rate, traditional chinese medicine (TCM) syndrome score, alpha-fetoprotein and child-pugh grade were compared between the two groups. The serum metabolites of the two groups before and after treatment were screened by ultra-high liquid chromatography-mass spectrometry technology, and the metabolic pathways and related biological pathways were analyzed. RESULTS: The one-year recurrence rate of the treatment group was significantly lower than that of the placebo group, and the overall improvement rate of TCM syndrome score was significantly better than that of the placebo group (P<0.05). There was no statistical significance in the comparison of alpha-fetoprotein and child-pugh grade between the two groups after treatment (P>0.05). Metabolomics results showed that there were 39 and 33 different metabolites in the treatment group before and after treatment and in the two groups after treatment, respectively. After enrichment analysis and topological analysis of the different metabolites, it was found that Fuzheng Xiaoliu Granules could affect amino acid metabolism, fatty acid metabolism and purine metabolism and other metabolic pathways. Before and after treatment in the treatment group and after treatment in the two groups, there were the same differential metabolites and metabolic pathways in the two comparison results. The same differential metabolites with FOLD CHANGE>1 include Stearic acid, Hypoxanthine, Kynurenic acid, Arachidonic acid, and N-Arachidonoyl Dopamine. The same metabolic pathways with Impact>0.1 include Arachidonic acid metabolism and Histidine metabolism. CONCLUSION: Fuzheng xiaoliu granules can effectively reduce the recurrence rate of stage II liver cancer patients after comprehensive intervention and improve the TCM syndrome. It may inhibit the activation of PI3K/Akt and ERK signaling pathways by regulating the content of metabolites involved in metabolic pathways such as amino acids and fatty acids, thereby delaying tumor recurrence.

Objective    To evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation. Methods    From May 2014 to July 2018, 144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command were selected. Among them, there were 69 patients in a non-elderly group (<60 years) including 18 males and 51 females aged 52.07±5.56 years, and 75 patients in an elderly group (≥60 years) including 32 males and 43 females aged 65.23±4.29 years. A propensity-score matching (PSM) study was conducted to eliminate confounding factors. Both groups underwent mitral valve surgery and cryoablation at the same time. A 2-year follow-up was conducted after discharge from the hospital, and the perioperative and postoperative efficacy indexes were compared between the two groups. Results    After PSM analysis, there were 56 patients in each group. The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%, and the cardiac function was graded asⅠorⅡ, which was significantly improved compared with that before the surgery, but there was no statistical difference between the two groups (P>0.05). Among the perioperative indicators of the two groups, the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group (P<0.05), and the differences in other indicators were not statistically different (P>0.05). Conclusion    The mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe, and the short-term outcome is satisfactory.