Diabetic retinopathy is one of the most common and specific chronic complications of diabetes mellitus,which is a serious and irreversible progressive blinding eye disease.The visual im-pairment caused by the progression of the disease and the economic burden caused by the treatment of the disease lead to psychological problems such as anxiety and depression,affecting the quality of life and physical and mental health,and increasing the burden on the family and society.This article re-viewed the current status of epidemiological research on DR,discussed the correlation of DR with anxiety and depression and its influencing factors,analyzed the research progress of evaluation and in-tervention methods,aiming to provide assistance for improving patients'treatment compliance and quality of life.

Objective:To explore the effectiveness of body weight support in gait training after surgery for an ankle fracture.Methods:Thirty-eight ankle fracture patients who received surgery were divided at random into an observation group and a control group, each of 19. In addition to 3 sessions of routine gait rehabilitation training a week for 6 weeks, only those in the observation group received body weight support training with body weight support boots. Gait data were collected using the GaitWatch three-dimensional gait action capture and training system before the training and after 2, 4 and 6 weeks of the training.Results:At each assessment the gait frequency, gait cycle, stride length, stride rate, bilateral step length, step length deviation, bilateral support phase and bilateral swing phase of both groups had improved significantly. After 6 weeks the average stride frequency, gait cycle, stride length on both sides and speed of the observation group had improved significantly more than among the control group. Step length deviation was not significantly different, however. At each evaluation the proportions of affected and healthy side support had decreased significantly in both groups, but affected and healthy side swing had increased and the proportion of bilateral support had decreased significantly.Conclusion:Body weight support training with body weight support boots can significantly improve gait after ankle fracture surgery. Its effect is superior to that of conventional gait training.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective:To investigate the expression of minichromosome maintenance protein 4 (MCM4) in bladder cancer and its correlation with proliferating cell nuclear antigen (PCNA).Methods:The expression of MCM4 in bladder cancer tissues and adjacent normal tissues was analyzed in the gene expression profiling interactive analysis (GEPIA) database. Paraffin sections of bladder cancer tissues and adjacent normal tissues from 72 patients admitted to the Department of Urology, the Third Affiliated Hospital of Xinxiang Medical College from June 2020 to May 2022 were collected. The expression of MCM4 in bladder cancer tissues and adjacent normal tissues was examined by immunohistochemical staining. The relationship between MCM4 expression and clinicopathologic features and prognosis of bladder cancer patients was analyzed. Bladder cancer T24 and 5637 cells were cultured in vitro, and the control and transfection groups were established. The cells in the transfection group were transfected with short hairpin RNA (shRNA) to knock down MCM4. The expression of MCM4 was evaluated by real-time reverse transcription-PCR (RT-qPCR) and Western blotting. The effect of MCM4 on bladder cancer cell proliferation was evaluated by clonogenic assay, cell counting kit-8 (CCK-8) assay, and cell cycle assay. A nude mouse model was established using BALB/c nude mice and T24 cell, and the effect of MCM4 on tumor growth was evaluated by Western blotting. The correlation between MCM4 and PCNA was investigated by GEPIA database and immunohistochemical staining. Results:The GEPIA database analysis showed that the relative expression of MCM4 in bladder cancer tissues ( n=404) was higher than that in adjacent normal tissues ( n=28, P<0.05). The expression of MCM4 in bladder cancer tissues was higher than that in adjacent normal tissues, and no higher expression was observed in adjacent normal tissues. The expression level of MCM4 was closely correlated with tumor size in the low-expression group and high-expression group of patients ( χ2=10.892, P=0.001), but not with age ( χ2=1.583, P=0.208), gender ( χ2=0.011, P=0.915), and tumor differentiation ( χ2=0.196, P=0.658). The 5-year overall survival rate was significantly reduced in patients with high MCM4 expression ( P=0.013). Compared with the control group [(1.0±0.2), (1.0±0.2)], the expression of MCM4 gene [(0.4±0.1), (0.4±0.1)] in the transfection group of T24 and 5637 cells were lower (both P<0.05). Compared with the control group [(1.0±0.2), (1.0±0.2)], the expressions of MCM4 protein [(0.5±0.1), (0.3±0.1)] in the transfection group of T24 and 5637 cells were lower (both P<0.05). Compared with the control group [(150±16), (160±18) unit], the clonal cell number [(110±11), (120±12) unit] of T24 and 5637 cells in the transfection group were decreased (both P<0.05). Compared with the control group [(1.0±0.2), (1.0±0.2)], the absorbance ( A) value [(0.4±0.1), (0.5±0.1)] of T24 and 5637 cells in the transfection group were decreased (both P<0.05). Compared with the control group [(77±7)%, (67±7)%], the transfection group blocked the G 1/S phase [(89±8)%, (76±8)%] of T24 and 5637 cells (both P<0.05). Compared with the control group, the tumor volume in the transfection group was significantly smaller [(196±16) mm 3vs (304±25) mm 3, P<0.05], and the expression of MCM4 protein in T24 cell in the transfection group was lower [(0.5±0.1) vs (1.0±0.2), P<0.05]. GEPIA database analysis showed a correlation between MCM4 and PCNA ( R=0.61, P<0.05), and bladder cancer patients with high MCM4 expression also had similarly high PCNA expression. Conclusions:MCM4 is highly expressed in bladder cancer tissues and may promote colorectal cancer proliferation by affecting PCNA.

Objective:To evaluate the new model of group screening combined with opportunistic screening for the diagnosis and treatment of gastric cancer.Methods:Group screening combined with opportunistic screening was used for gastric cancer screening. (1) Group screening. Cluster sampling was used to screen gastric cancer by endoscopy in high-risk population (aged 40-<70 years) of rural residents in Weihai from July 2017 to December 2020, and biopsy was obtained for histopathology if necessary. Main collection parameters included the detection rate of advanced gastric cancer, early gastric cancer and high-grade intraepithelial neoplasia (HGIN). (2) Opportunistic screening. The changes of the detection rates of early gastric cancer in opportunistic screening in 2 hospitals in Weihai area were observed during the same period of time.Results:(1) In group screening, from July 2017 to December 2020, the first batch of 8 000 cases of gastric cancer screening were completed. The cases of advanced gastric cancer, early gastric cancer and HGIN were 36, 28, and 62, respectively. The detection rates of gastric cancer and early gastric cancer were 0.80% (64/8 000) and 43.75% (28/64), respectively. The proportion of early gastric cancer+HGIN who received endoscopic submucosal dissection (ESD) was 77.78% (70/90), and the rate of curative resection was 100.00%(70/70). (2) Opportunistic screening: from July 2017 to December 2020, the annual early gastric cancer detection rates in opportunistic screening in Wendeng District Traditional Chinese and Western Medicine Hospital were 16.67% (1/6), 20.00% (3/15), 23.53% (4/17), and 33.33% (6/18) in the consecutive 4 years, respectively. The annual detection rates of early gastric cancer in opportunistic screening in Ru Shan Peoples Hospital were 14.74% (14/95), 23.80% (60/252), 25.49% (65/255), and 24.04% (50/208), respectively. The detection rates of opportunistic screening for early gastric cancer in hospitals in Weihai city increased year by year.Conclusion:In areas with high incidence of gastric cancer, a certain scale of group screening can lead to a wider range of opportunistic screening, resulting in the increase of the detection rate of early gastric cancer. The new model of diagnosis and treatment of gastric cancer is worth recommendation.

Menopausal syndromes are mostly based on kidney deficiency， which could be expalined that kidney governing essence storage and controlling innateness， so when the kidney water was deficient and the liver fail to nourish， then led to liver depression and transform into fire； deficiency of the kidney， loss of warmth of the spleen， and inability to transport and transform the water and dampness will easily lead to phlegm and fire； the decline of the kidney yin and loss of water and fire will easily cause the exuberance of heart fire. Therefore， clinical symptoms of hot flashes， insomnia， and palpitations are common due to phlegm， depressions， and fire. Based on this， at the beginning of the treatment， we should treat the symptoms firstly by resolving phlegm， relieving depression and clearing fire， and commonly use Huanglian Wendan Decoction （黄连温胆汤）， Yigan Powder （抑肝散）， Chaihu plus Longgu Muli Decoction （柴胡加龙骨牡蛎汤）， and Qingxin Zishen Decoction （清心滋肾饮）， etc. After improving the symptoms of hot flashes and sweating， irritability， dreaming and frightening， then we should give the prescriptions to tonify kidney yang and nourish kidney yin， in order to eliminate the pathogens and reinforce healthy qi， and to treat both the manifestations and the root cause， so that the symptoms of the patients can be better alleviated.

Objective : To study the effect of anterior traction on the temporomandibular joint in adolescent patients with skeletal Class Ⅲ malocclusion. Methods: Twenty-nine patients with early permanent dentition with skeletal class Ⅲ malocclusions were measured by cephalometry and a coordinate system before and after maxillary protraction. The correlation between dentofacial structures and the temporomandibular joint was analyzed. Results : After maxillary protraction, cephalometric measurements showed that the dentofacial structure changed significantly; ANB increased by 3.97° ± 2.32° (P<0.001); U1-SN increased by 4.97° ± 5.51° (P<0.001); L1-MP decreased by 1.26° ± 1.41° (P = 0.008); and MP-SN increased by 1.02° ± 3.90° (P = 0.003). The coordinate system measurement showed that the S-Fpx was decreased by 0.16 ± 1.52 mm (P = 0.041), the S-Ciy distance was significantly decreased by 0.09 ± 2.03 mm (P = 0.028), and there was no significant change in the temporomandibular joint spaces (A, P, and C) (P>0.05). Correlation analysis showed a moderate negative correlation between the posterior margin of the temporomandibular joint fossa and U1-SN (r = -0.427, P = 0.042). There was a moderate positive correlation between the leading edge of the condyle and ANB (r = 0.425, P = 0.043); there was no correlation between the joint space and dentofacial changes. Conclusion After treatment with maxillary protraction for adolescent skeletal class Ⅲ malocclusion, maxillary protraction had some effect on changes in the temporomandibular joint fossa and condyle and had no effect on the joint space.

Objective:To explore the effect of music relaxation training (MRT) in patients with breast cancer after axillary lymph node dissection (ALND) .Methods:A total of 72 breast cancer patients admitted to Qingdao Central Hospital and Qingdao Cancer Hospital from January 2019 to January 2021 were selected for control experiments. All patients were treated with ALND based on their specific conditions. According to the random number table method, the patients were divided into the control group and the intervention group, each with 36 cases. The control group carried out routine nursing, and the intervention group conducted MRT on the basis of routine nursing. The Short Form 36 Health Survey (SF-36) and Visual Analog Scale (VAS) scores of the two groups before treatment and at discharge were compared.Results:After the intervention, the SF-36 score and satisfaction of the intervention group were higher than those of the control group, and the VAS score was lower than that of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of MRT after ALND in breast cancer patients can improve the health of patients, increase patient satisfaction, and reduce their pain.

Objective:To investigate the efficacy and safety of recombinant activated factor Ⅶ(rFⅦa)on uncontrolled perioperative hemorrhage in elderly patients in surgical intensive care unit(SICU).Methods:Clinical data of 27 elderly patients with uncontrolled perioperative hemorrhage treated successfully with rFⅦa in surgery-ICU of our hospital from May 2004 to December 2018 were retrospectively analyzed.And the application method and experience were summarized.Results:Of the 27 patients, 16 cases were cured, 11 cases died, and the total fatality rate was 40.74%(11/27). The bleeding stopped in 23 cases, four cases died of uncontrolled peri-operative hemorrhage, and the hemorrhage-caused fatality rate was 14.81%(4/27). Seven patients died of primary diseases after the control of bleeding, with a fatality rate of 25.93%(7/27 ). The thrombin time(TT), prothrombin time(PT), activated partial thromboplastin time(APTT)and international normalized ratio(INR)were reduced and the prothrombin activity(AT)was increased after versus before the application of rFⅦa( Z=-2.197, -3.180, -2.271, -2.803 and 2.756, P=0.028, 0.001, 0.023, 0.005 and 0.006, respectively). Conclusions:rFⅦa has a better effect on uncontrolled peri-operative hemorrhage in elderly patients, when traditional treatments are ineffective.

Objective:To investigate the technical points and clinical application of combined infratemporal fossa approaches (CIFA) by analyzing the clinical results with CIFA for lesions involved skull base.Methods:A retrospective study was performed on 11 patients underwent CIFA for skull base lesions dissection from December 2014 to January 2019 in the department of otolaryngology, Peking Union Medical College Hospital. There were 6 male and 5 female patients, with age range of 16-72 years old and median age of 53 years old. Five patients underwent CIFA Type B and D, and the other 6 underwent CIFA A and B. All patients were followed up regularly by CT and MRI to observe possible recurrence.Results:Among the 5 patients with CIFA Type B and D, 3 were giant cell tumor and 2 were giant cell reparative granuloma, and median maximum cross-section size was 42 mm×46 mm (range from 37 mm×18 mm to 56 mm×53 mm). Among the 6 patients with CIFA Type A and B, 4 were paraganglioma of head and neck, 1 was schwannoma of skull base, 1 was petrous cholesteatoma, and median maximum cross-section size was 43 mm×36 mm (range from 24 mm×22 mm to 63 mm×35 mm). Nine patients underwent complete resection of the tumor in the first stage. In 2 patients, the extracranial parts were removed in the first stage, and the intracranial part was removed in the second stage. Tympanum and ossicular reconstruction were done in one of the CIFA Type B and group D, and 1 year′s postoperative hearing was mild conductive hearing loss. There was no cerebrospinal fluid leakage of all patients. All the 5 patients with normal facial nerve function before surgery recovered to H-B grade Ⅰ to Ⅱ within 3 months after surgery. Among the 4 patients whose preoperative facial nerve function were grade Ⅱ, 2 recovered to grade I after surgery and the other 2 were still grade Ⅱ. For the patient whose preoperative facial nerve function was grade Ⅴ, his postoperative recovery was grade Ⅲ. There was 1 patient whose pre-operative FN function was H-B grade Ⅲ, and the post-operative FN function was grade Ⅵ due to FN resection. Except for 2 cases with cochlear involved before surgery, cochleae of the other 9 cases were preserved. The follow-up time was 14 to 58 months. No recurrence was observed in all patients.Conclusions:The CIFA can safely and completely remove the extensive lesions that invade the skull base, and the facial nerve function can be well protected and recovered intro-and post-operation. Appropriate use of combined IFA can not only achieve good exposure and complete resection of lesions, but also create conditions for functional reconstruction.