Objective To observe the clinical efficacy of dynamic joint mobilization combined with core stability training in the treatment of nonspecific low back pain.Methods 60 patients with nonspecific low back pain were randomly assigned into either the treatment group or control group.Each group had 30 patients.The treatment group received a therapeutic regimen combining dynamic joint mobilization and core stability training,while the control group only received core stability training.Both groups were evaluated for therapeutic effectiveness using the Visual Analogue Scale(VAS)for pain,the Oswestry Disability Index(ODI),and the range of motion(ROM)of the lumbar spine before treatment,and at the 1st,3rd,and 6th weeks after treatment.At the conclusion of the treatment,a thorough assessment of the overall therapeutic efficacy was performed.Results At the 1st,3rd,and 6th weeks post-treatment,both groups showed statistically significant differences in VAS scores,ODI scores,and ROM scores over time(P＜0.05).The improvements in these indices were significantly greater in the treatment group compared to the control group(P＜0.05).The treatment group had considerably higher therapeutic effective-ness compared to the control group(P＜0.05).Conclusions Dynamic joint mobilization combined with core stabil-ity training is effective in treating nonspecific low back pain.It can help with pain relief,lumbar and back function restoration,and lumbar and back mobility improvement.This approach is worthy of clinical application and promotion.

Objective:To evaluate the long-term efficacy of percutaneous microwave ablation (MWA) therapy for hepatocellular carcinoma.Methods:2054 cases with Barcelona Clinic Liver Cancer (BCLC) stage 0~B at the Fifth Medical Center of the Chinese People's Liberation Army General Hospital from January 2006 to September 2020 were retrospectively collected. All patients were followed up for at least 2 years. The primary endpoint of overall survival and secondary endpoints (tumor-related survival, disease-free survival, and postoperative complications) of patients treated with ultrasound-guided percutaneous MWA were analyzed. Kaplan-Meier method was used for stratified survival rate analysis. Fine-and-Gray competing risk model was used to analyze overall survival.Results:A total of 5 503 HCC nodules [mean tumor diameter (2.6±1.6) cm] underwent 3 908 MWAs between January 2006 and September 2020, with a median follow-up time of 45.6 (24.0 -79.2) months.The technical effectiveness rate of 5 375 tumor nodules was 97.5%. The overall survival rates at 5, 10, and 15-years were 61.6%, 38.8%, and 27.0%, respectively. The tumor-specific survival rates were 67.1%, 47.2%, and 37.7%, respectively. The free tumor survival rates were 25.8%, 15.7%, and 9.9%, respectively. The incidence rate of severe complications was 2.8% (108/3 908). Further analysis showed that the technical effectiveness and survival rate over the passing three time periods from January 2006-2010, 2011-2015, and 2016-September 2020 were significantly increased, with P ?

ObjectiveTo investigate the performance of fibrosis-4 （FIB-4） versus aspartate aminotransferase-to-platelet ratio index （APRI） in predicting advanced liver fibrosis and disease progression in patients with chronic HBV infection. MethodsA total of 497 patients with chronic HBV infection who underwent liver biopsy in The First Affiliated Hospital of Guangxi Medical University from February 2013 to December 2022 were enrolled， among whom 404 were enrolled in a retrospective study and 75 were enrolled in a prospective study. Related indicators were collected， including demographic features （sex and age）， biochemical indices （alanine aminotransferase ［ALT］ and aspartate aminotransferase ［AST］）， and platelet count， and FIB-4 and APRI were calculated. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups； the chi-square test was used for comparison of categorical data between groups. The area under the ROC curve （AUC） was used to assess the ability of APRI and FIB-4 in evaluating liver fibrosis degree and disease progression in patients with chronic HBV infection. ResultsIn the retrospective analysis， compared with the FIB-4<2.67 group， the FIB-4≥2.67 group had a significantly higher proportion of the patients who were diagnosed with liver cirrhosis or hepatocellular carcinoma （66.19% vs 47.54%， χ²=12.75， P<0.001）. The medians of FIB-4 and APRI increased significantly with liver fibrosis degree from F0 to F4 （H=42.5 and 35.9， both P<0.001）. As for the fibrosis stage of F0-F4， the median of FIB-4 was significantly higher than that of APRI in the patients with the same fibrosis stage （H=59.71， P<0.001）. FIB-4 and APRI had a similar AUC for predicting stage F3 fibrosis （0.67 vs 0.65， Z=0.71， P=0.480）， while FIB-4 had a higher AUC for predicting stage F4 fibrosis than APRI （0.72 vs 0.64， Z=10.50， P<0.001）. In the prospective study cohort， FIB-4 and APRI showed an increasing trend over time in predicting disease progression （chronic hepatitis B to liver cirrhosis）， with an AUC of 0.718 （95% confidence interval ［CI］： 0.476‍ ‍—‍ ‍0.760） and 0.555 （95%CI： 0.408‍ ‍—‍ ‍0.703）， respectively， and FIB-4 had a significantly higher accuracy than APRI in predicting disease progression （χ²=12.44， P<0.001）. ConclusionFIB-4 and APRI can be used to evaluate advanced liver fibrosis （F3 and F4） and predict disease progression， and FIB-4 is superior to APRI in certain aspects.

Objective:To investigate the genomic manifestation and pathogenesis of osteosarcoma with different relapse pattens, which were respectively initially presented with bone metastasis or pulmonary metastasis.Methods:From May 1, 2021 to October 1, 2021, 38 fresh tumor specimens and some paraffin-embedded specimens of high-grade osteosarcoma were collected in Peking University People's Hospital, including 29 males and 9 females, aged 19.6±2.2 years (range, 6-61 years). Among the 38 cases, 12 cases had initial bone metastasis (group A) and 26 cases had initial lung metastasis (group B), of which 15 cases (40%, 15/38) had paired specimens of primary and metastatic lesions. Based on Illumina NovaSeq 6000, we analyzed whole-exome sequencing (WES) as well as transcriptome for osteosarcoma with paired samples in different relapse patterns. During all their treatment courses, we also collected their paired samples to reveal these tumors' evolution. We sought to redefine disease subclassifications for osteosarcoma based on genetic alterations and correlate these genetic profiles with clinical treatment courses to elucidate potential evolving cladograms.Results:We found that osteosarcoma in group A mainly carried single-nucleotide variations (83%, 10/12), displaying higher tumor mutation burden [4.9 (2.8, 12.0) & 2.4 (1.4, 4.5), P=0.010] and neoantigen load [743.0 (316.5, 1,034.5) & 128.5 (49.0, 200.5), P=0.003], while those in group B mainly exhibit structural variants (58%, 15/26). The mutation spectrum showed that there was a significant difference in age-related gene imprinting 1 between the bone metastasis group and the lung metastasis group ( P=0.005). Samples were randomly selected from group A (3 patients) to investigate immunologic landscape by multiplex immunohistochemistry, from which we noticed tertiary lymphatic structure from one patient from group A. High conservation of reported genetic sequencing over time was found in their evolving cladograms. Conclusion:Osteosarcoma with mainly single-nucleotide variations other than structural variants might exhibit biological behavior predisposing toward bone metastases with older in age as well as better immunogenicity in tumor microenvironment.

Objective:To systematically evaluate the qualitative researches on symptom burden and psychological experience of patients with myasthenia gravis, so as to provide references for improving the support system of this population and promoting their physical and mental health.Methods:Qualitative researches on symptom burden and psychological experience in patients with myasthenia gravis were searched on PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CINAHL, Scopus, Proquest, Ovid, Wiley Online Library, Springer Link, China National Knowledge Infrastructure, VIP, Wanfang Dadabase and China Biology Medicine disc. The search period was from the establishment of the database to December 31, 2022. The quality evaluation criteria of Evidence-Based Health Care Center of Joanna Briggs Research Institute (JBI) in Australia was used to evaluate the quality of the literature, and the Meta-synthesis of the literature was performed using the pooled integration method.Results:A total of 8 studies were included, 66 study results were extracted, 10 new categories were summarized, and 4 integrated results were synthesized, including patients with myasthenia gravis suffering from physical symptoms leading to mental fatigue and cognitive impairment, effects of myasthenia gravis on physical, social, psychological functions and work in patients, difficulties and challenges encountered in the course of treatment and attitude , behavior change, responsibility and mission assumption and personal growth achievement.Conclusions:Patients with myasthenia gravis have serious symptom burden and psychological distress. Clinical nursing staff should attach importance to patient symptom management, pay attention to their physical and mental feelings, provide multi-dimensional social support, help patients actively face disease challenges and achieve personal growth.

Nearly a decade of curriculum update in American medical colleges and universities are summarized in this paper. This paper introduces the situation of sampling survey of colleges and universities. The results show the diversity of medical curriculum integration, reflecting the concept of multi-disciplinary integration of basic disciplines, clinical disciplines and public health and social sciences, and giving experiences such as early clinical practice, providing personalized talent cultivation approaches, and designing competency-oriented curriculum system. Combined with the current situation of medical education curriculum reform in China, it's suggested to explore the construction of medical curriculum system with Chinese characteristics, so as to contribute to the cultivation of excellent physicians for implementing Healthy China Initiative.

Objective:To explore the mediating role of family cohesion between family expressiveness and preschool children's behavior.Methods:Using the method of stratified cluster random sampling, the parents of 1 213 children in Shenzhen kindergartens were assessed by the Achenbach child behavior checklist (parent questionnaire) (CBCL, 4-16 years) and family environment scale-Chinese version (FES-CV). After the survey, SPSS 24.0 was used to conduct the data analysis and the Bootstrap method was used to test the mediation effect.Results:(1)The total score of children's behavior 147.0(135.0, 163.0) was found to be significantly negatively correlated with family expressiveness score 6.0 (5.0, 7.0) and family cohesion score 8.0 (6.0, 9.0), and the correlation coefficients were -0.145 and -0.187(both P<0.01). (2) Family expressiveness score was positively related to family cohesion score ( r=0.443, P<0.01). (3)The direct effect of family expressiveness on children's behavior was -0.072, and the 95% confidence interval was (-0.133, -0.010). Family cohesion had a mediating effect between family expressiveness and children's behavior, 95% confidence interval was (-0.129, -0.058), and the mediating effect accounted for 56.4% of the total effect. Conclusion:Family cohesion plays a partial mediating role between family expressiveness and children's behavior.

Objective The epidemiology of Acinetobacter baumannii isolates from bloodstream infections,their antibiotic resistance profiles and virulence-associated factors were studied.Methods A total of 90 isolates from 17 hospitals were collected from the patients with bloodstream infections during July 2013 and July 2014.Vitek-2 Compact system was used for identification of the strains and antibiotic susceptibility testing.The epidemiology was studied by pulsed-field gelectrophoresis(PFGE).Drug-resistant genes and associated virulence genes were amplified by PCR.Results According to antimicrobial susceptibility testing,75 isolates are multi-drug resistant Acinetobacter baumannii.PFGE results showed that 75 multi-drug resistant Acinetobacter baumannii isolates belonged to eight clone types(A to H),with the A (n=51)and B (n=14)clone being the dominant PFGE clone types.Different clone isolates spread in different hospitals.Most of the hospitals were given priority to with clone A.Clone A only maintaining high sensitive rate to cefoperazone/sulbactam、amikacin and tigecycline.Virulence gene abaI,cusE,ompA,bap,bfms detection rates are 93.3% (84/90),92.2% (83/90),100.0% (90/90),84.4% (76/90),92.2% (83/90),respectively.There were 7 mucoid isolates,which are all multi-drug resistant Acinetobacter baumannii,all belong to clone B and all associated virulence genes can be detected.Conclusions The dominant clone type of multi-drug resistant Acinetobacter baumannii from bloodstream infections is clone A.The abaI-,bap-and bfms-positive strains are associated with a higher incidence of antibiotic resistance in most types of antimicrobials.The acquisition of mucous type may indicate the emergence of virulent strains,which should be paid attention to during clinical treatment.

Objective To understand the life quality status of freshmen in higher medical colleges,and discuss the factors influencing the quality of life,in order to improve their life quality,and put forward the countermeasures and suggestions.Methods We randomly selected a higher medical colleges and universities in Yunnan,the grade one students were investigated with SF-36 scale investigation,the data were analyzed by t test and multiple linear regression analysis.Results The quality of life scores (PCS,MCS) of freshmen in this medical college are lower than the national norm,the segmentation in the field of eight only GH is higher than the national norm,and the RP,BP,VT,RE are lower than the national norm.There are six factors into the regression equation of the quality of life:health,insomnia,life pressure,communicating with people,life rule.Conclusions The QOL of freshmen in higher medical colleges and universities is low,relevant departments should be caused to take seriously.To improve the QOL,the government,society,school,personal must make joint efforts in many ways,and take targeted measures.

Objective To investigate the correlation of motor function and emotion, cognition in patients after stroke. Methods 15 sub-acute stroke patients were included. They were assessed with Fugl-Meyer Assessment (FMA)、10 m walking speed, Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Mini-Mental State Examination (MMSE), modified Barthel Index (MBI) and SF-36. Fractional anisotropy (FA) values, apparent diffusion coefficient (ADC), and asymmetry indices of ADC and FA were obtained from diffusion tensor imaging. The correlation among them were analyzed. Results There was no correlation between the scores of FMA, 10 m walking speed and HAMD, HAMA, MMSE (P>0.05). The scores of HAMD, HAMA and MMSE correlated with emotional function of SF-36 (P<0.05). The HAMA score negatively correlated with body pain of SF-36. The FA value of the posterior limb of the internal capsule were negatively correlated with HAMD (P<0.05). Conclusion Neural network defect can cause emotion changes in stroke patients, but the motor function was not correlated with the emotion. Emotion and cognition may affect quality of life in these patients.