To investigate the application value of disposable subscope-assisted intestinal metal stent placement in the treatment for acute malignant colorectal obstruction, a retrospective analysis was conducted on the patients who underwent intestinal metal stent placement assisted by disposable subscope for acute malignant colorectal obstruction at the Digestive Endoscopy Center, Affiliated Hospital of Yangzhou University from June 2023 to July 2024. The technical success rate, clinical success rate, operation time, postoperative complications and first-stage surgical resection anastomosis rate of intestinal metal stent placement assisted by subscope were analyzed. Among the 16 included patients, there were 10 males and 6 females, with the age of 72.19±9.40 years. Obstruction occurred at the descending colon in 8 cases (50.00%), at the sigmoid colon in 6 cases (37.50%), at the rectosigmoid junction in 1 case (6.25%), and at the splenic flexure of the transverse colon in 1 case (6.25%). All 16 patients successfully underwent stent placement, with a technical success rate of 100.00% (16/16). Obstruction symptoms did not relieve in one patient (6.25%) after stent placement, resulting in a clinical success rate of 93.75% (15/16). The endoscopic operation time for the 16 patients was 37.8±13.9 minutes. No bleeding, perforation, stent displacement, or detachment occurred after the operation. Fourteen patients underwent subsequent surgical treatment, the first-stage surgical resection anastomosis rate was 71.43% (10/14). This preliminary study suggests that the disposable subscope-assisted intestinal metal stent placement for the treatment of acute malignant colorectal obstruction is safe and effective, with no radiation exposure.

Objective:To analyze the efficacy of phantom-less quantitative computer tomography (PL-QCT) for the diagnosis of osteoporosis in patients with lumbar degenerative diseases.Methods:From October 2021 to October 2023, a total of 1 248 patients with lumbar degenerative disease who did not receive anti-osteoporosis treatment in the Department of Spine Surgery, Tianjin Hospital were retrospectively analyzed. There were 520 males and 728 females, aged 62.31±9.37 years (range, 40-87 years), height 1.66±0.08 m (range, 1.43-1.89 m), weight 69.04±8.27 kg (range, 49-93 kg). The mean body mass index was 26.11±3.67 kg/m 2 (range, 14.40-37.11 kg/m 2). Dual-energy X-ray absorptiometry (DXA) and PL-QCT were used to diagnose osteoporosis, and the detection rates of the two diagnostic methods were compared. The receiver operating characteristic (ROC) curve of PL-QCT for the diagnosis of osteoporosis was drawn, the area under the curve (AUC) and 95% confidence interval (CI), sensitivity and specificity were calculated. Results:Among 1 248 patients with lumbar degenerative diseases, 626 (50.2%) were diagnosed as osteoporosis by PL-QCT, 423(33.9%) were diagnosed by spine DXA, 488(39.1%) were diagnosed by hip DXA and 539 patients(43.2%) were diagnosed by dual-site DXA. The detection rate of osteoporosis of PL-QCT was higher than that of spine DXA (χ 2=193.557, P<0.001), hip DXA (χ 2=322.201, P<0.001) and dual-site DXA (χ 2=94.683, P<0.001), and the difference was statistically significant. Taking the diagnostic results of spinal DXA for osteoporosis as a reference, the ROC curve of PL-QCT for the diagnosis of osteoporosis showed a sensitivity of 79%, a specificity of 81%, and an AUC and 95% CI of 0.82(0.79, 0.85). Taking the diagnostic results of hip DXA for osteoporosis as a reference, the ROC curve of PL-QCT for the diagnosis of osteoporosis showed a sensitivity of 85%, a specificity of 55%, and an AUC and 95% CI of 0.75(0.71, 0.78). Taking the diagnostic results of two-site DXA for osteoporosis as a reference, the ROC curve of PL-QCT for the diagnosis of osteoporosis showed a sensitivity of 72%, a specificity of 75%, and an AUC and 95% CI of 0.81(0.78, 0.83). Conclusion:Compared with DXA, PL-QCT has a higher detection rate of osteoporosis in patients with degenerative lumbar spine disease and good diagnostic efficacy.

Objective:To explore the effect of vitamin D supplement on chronic musculoskeletal pain (CMP) in patients with ankylosing spondylitis (AS) through a cohort study and provide evidence for optimizing vitamin D supplement strategies in AS management.Methods:Based on the large-scale prospective cohort of the UK Biobank, a total of 1 497 middle-aged and older patients diagnosed with AS were included. Patients were categorized into three groups according to their baseline vitamin supplements usage: non-vitamin supplement group ( n=978), vitamin D supplement group ( n=65), and other vitamin supplements group ( n=454). The occurrence of CMP was obtained by baseline pain survey and follow-up data from 2019—2020 and 2022—2023. A generalized linear mixed model (GLMM) was used to analyze the association between vitamin D supplement and CMP occurrence, with odds ratio ( OR) and its 95% confidence intervals ( CI) calculated. To verify robustness of the study findings, propensity score matching was employed to match participants in the vitamin D supplementation group with those in the non-vitamin supplement group and the other vitamin supplements group for sensitivity analysis. Results:After adjusting for confounding factors such as demographic characteristics, lifestyle, and co-morbidities, GLMM analysis did not find significant association between vitamin D supplement and the risk of CMP occurrence in AS patients [ OR(95% CI)=0.85(0.48, 1.48), P=0.555]. However, GLMM analysis indicated that male AS patients had a lower likelihood of developing CMP compared to female patients [ OR(95% CI)=0.69(0.56, 0.86), P<0.001]. Additionally, current smoking [ OR(95% CI)=1.46(1.06, 2.03), P=0.022] and poorer overall health status-categorized as general [ OR(95% CI)=2.32(1.85, 2.90)] or poor [ OR(95% CI)=2.31(1.68, 3.18), P<0.001] were associated with an increased risk of CMP occurrence. In the sensitivity analysis, no significant association was observed between vitamin D supplement and CMP. Conclusion:Vitamin D supplement does not reduce the risk of CMP occurrence in middle-aged and old AS patients. However, female, smoking, and poor overall health status are identified as risk factors for CMP in AS patients. Future research should focus on large-scale real-world studies, particularly in younger AS populations, to further investigate the relationship between vitamin D supplement and CMP, thereby providing more targeted intervention strategies.

Objectives:To investigate the clinical efficacy of staged percutaneous endoscopic posterior decom-pression for treating multi-segment thoracic ossification of ligamentum flavum(mTOLF).Methods:The clinical data of 16 patients with mTOLF who were treated with staged percutaneous endoscopic posterior decompres-sion at our hospital between June 2021 and June 2023 were retrospectively analyzed,including 9 males and 7 females,aged 46-67(55.4±6.8)years old.The preoperative imaging examinations of the patients indicated multi-segment ossification of ligamentum flavum,including double segments in 14 cases and triple segments in 2 cases.The responsible segments were as follows:upper thoracic spine(T1-T4)in 4 cases,middle thoracic spine(T5-T9)in 6 cases,and lower thoracic spine(T10-T12)in 24 cases.Staged percutaneous endoscopic posterior decompression was performed for mTOLF,targeting only one responsible segment in each surgery.The operative time,blood loss,hospitalization days,and complications were recorded.The Oswestry disability index(ODI)and the modified Japanese Orthopaedic Association(mJOA)11-point scale scores were recorded preoperatively,on 3d postoperatively,and at the final follow-up,and the mJOA improvement rate at the final follow-up was calculated.Statistical analysis was performed to evaluate the clinical efficacy.The spinal canal area and the anterior-posterior spinal canal diameter were measured on CT images preoperatively,on 3d post-operatively,and at the final follow-up to evaluate the improvement of imaging findings.Results:All the 16 patients successfully completed the surgery,and no cerebrospinal fluid leakage or permanent lower limb paral-ysis occurred except for one dural tear during operation.The operative time was 80-205min(150.2±36.1min),blood loss was 30-70mL(50.3±12.4mL),hospitalization days were 9-15d(10.8±1.8d)and the follow-up time ranged from 9-20(14.3±3.2)months.The mJOA scores and ODIs before surgery,on 3d after surgery,and at the final follow-up were 5.7±1.3,7.1±1.3,8.5±1.4,and(41.4±1.8)％,(17.8±1.6)％,(15.6±1.3)％,respectively,which were both significantly improved on 3d postoperatively and at final follow-up compared with those val-ues before operation(P＜0.05).The mJOA recovery rate was 28.6％-100％[(56.1±19.3)％],and according to the mJOA evaluation criteria,the outcomes were classified as excellent in 3 cases,good in 9 cases,fair in 4 cases,and poor in no case,with an excellent and good rate of 75.0％.The spinal canal area and anterior-posterior diameter before surgery,on 3d after surgery,and at the final follow-up were 76.7±12.5mm2,159.9±22.1mm2,157.7±21.6mm2,and 7.4±0.5mm,15.5±0.9mm,15.3±0.9mm,respectively.Both the spinal canal area and anterior-posterior diameter on 3d postoperatively and at the final follow-up significantly increased com-pared to preoperative values(P＜0.05).Conclusions:Staged percutaneous endoscopic posterior decompression for treating mTOLF is safe and effective,and yields satisfactory clinical outcomes.

Objective:To explore the safety and efficacy of intrasaccular flow disruptor in intracranial aneurysms, including wide-necked aneurysms.Methods:A retrospective analysis was performed; 102 patients with intracranial aneurysms treated with intrasaccular flow disruptor at Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from August 2022 to November 2024 were enrolled; their clinical and imaging data were collected. The aneurysm characteristics and perioperative complications were summarized; aneurysm occlusion was evaluated by Woven EndoBridge occlusion scale (WOS) immediately after surgery and during the follow-up period.Results:Among the 102 aneurysms, 33 were anterior cerebral artery aneurysms, 40 were middle cerebral artery aneurysms, 17 were internal carotid artery aneurysms and 12 were basilar artery aneurysms; 73 aneurysms were regular intracranial saccular aneurysms and 29 were irregular saccular ones (17 of them with daughter sacs); 12 aneurysms were ruptured at acute phase. The surgical success rate was 100%: single intrasaccular flow disruptor was implanted into 95 patients, and stent-assisted or salvage treatments were given to 7 patients). Immediately after surgery, WOS grading A was noted in 5 patients, grading B in 7, grading C in 31, and grading D in 59. Two patients suffered severe perioperative complications and passed away: one patient died for ischemic complications that ensued after stent salvage treatment (parent artery being compressed by intrasaccular flow disruptor); the other patient died for hemorrhagic complications triggered by rupture of an initially unruptured aneurysm following intrasaccular flow disruptor implantation. Among them, 52 patients completed postoperative DSA follow-up, with a median follow-up of 205 (168, 292) days; WOS grading A was noted in 31 patients, grading B in 9, grading C in 8, and grading D in 4 at the last follow-up; the full occlusion rate was 92.3%, and no ischemic or hemorrhagic adverse events occurred.Conclusion:Intrasaccular flow disruptor shows high short-term safety and good efficacy in the treatment of intracranial aneurysms.

Approximately 30%-40% of epilepsy patients do not respond well to adequate anti-seizure medications (ASMs), a condition known as pharmacoresistant epilepsy. The management of pharmacoresistant epilepsy remains an intractable issue in the clinic. Its early prediction is important for prevention and diagnosis. However, it still lacks effective predictors and approaches. Here, a classical model of pharmacoresistant temporal lobe epilepsy (TLE) was established to screen pharmacoresistant and pharmaco-responsive individuals by applying phenytoin to amygdaloid-kindled rats. Ictal electroencephalograms (EEGs) recorded before phenytoin treatment were analyzed. Based on ictal EEGs from pharmacoresistant and pharmaco-responsive rats, a convolutional neural network predictive model was constructed to predict pharmacoresistance, and achieved 78% prediction accuracy. We further found the ictal EEGs from pharmacoresistant rats have a lower gamma-band power, which was verified in seizure EEGs from pharmacoresistant TLE patients. Prospectively, therapies targeting the subiculum in those predicted as "pharmacoresistant" individual rats significantly reduced the subsequent occurrence of pharmacoresistance. These results demonstrate a new methodology to predict whether TLE individuals become resistant to ASMs in a classic pharmacoresistant TLE model. This may be of translational importance for the precise management of pharmacoresistant TLE.
Epilepsy, Temporal Lobe/diagnosis* ; Animals ; Drug Resistant Epilepsy/drug therapy* ; Electroencephalography/methods* ; Rats ; Anticonvulsants/pharmacology* ; Neural Networks, Computer ; Male ; Humans ; Phenytoin/pharmacology* ; Adult ; Disease Models, Animal ; Female ; Rats, Sprague-Dawley ; Young Adult ; Convolutional Neural Networks

Objective To explore the preventive effect of multidisciplinary collaborative evidence-based nursing on dysphagia in patients with orotracheal intubation in intensive care unit(ICU)after extubation.Methods A retrospective analysis was performed on 200 patients with orotracheal intubation in ICU who were admitted to Dongguan Traditional Chinese Medicine Hospital between January and December 2023.Of them,96 patients who were admitted to our hospital between January and May 2023 received routine nursing(routine group),104 patients who were admitted to our hospital between June and December 2023 received multidisciplinary collaborative evidence-based nursing(evidence-based group).The incidence of dysphagia after extubation,water swallowing test result,swallowing function measured with M.D.Anderson dysphagia inventory(MDADI),psychological state assessed by connor-davidson resilience scale(CD-RISC),quality of life assessed by swallowing quality-of-life questionnaire(SWAL-QOL),and the incidence of dysphagia complications(aspiration,aspiration pneumonia,and malnutrition)were compared between the two groups.Results The incidence of dysphagia after extubation and the water swallowing test class in the evidence-based group were lower than those in the routine group(both P<0.05).The total score of MDADI and CD-RISC scores in the evidence-based group were significantly higher than those in the routine group(P<0.05),while the SWAL-QOL scores were lower(P<0.05).The incidence of complications in the evidence-based group was significantly lower than that in the routine group(P<0.05).Conclusion Multidisciplinary collaborative evidence-based nursing can effectively reduce the incidence of dysphagia in patients with orotracheal intubation in ICU after extubation,improve swallowing function,psychological state and quality of life,and reduce the incidence of complications.

Objective To compare the safety and efficacy of flow diverter with adjunctive spring coils(FAC)and simple flow diverter(FD)in the treatment of large or giant intracranial aneurysms.Methods The clinical data of 48 patients with large or giant intracranial aneurysm(55 intracranial aneurysms in total),who were treated at the First Affiliated Hospital of Zhengzhou University of China from January 2018 to September 2023,were retrospectively analyzed.According to the treatment method,the patients were divided into pure FD group and FAC group.The aneurysm occlusion rate and the incidence of procedure-related complications were compared between the two groups.Univariate and multivariate logistic regression analyses were used to identify risk factors for procedure-related complications.Results A total of 55 intracranial aneurysms detected in the 48 patients were included in this study.The median maximum diameter of aneurysms was 20.25 mm(16.45,24.62 mm).Among them,12 aneurysms were treated with FD alone,and 43 aneurysms were treated with FAC.The median follow-up time was 6.63 months(5.88,8.07 months).Compared with pure FD group,in FAC group the occlusion rate of aneurysms was significantly higher(86.1％vs.50.0％,P=0.023),while there was no statistically significant difference in the incidence of procedure-related complications between the two groups(18.18％vs.16.67％,P=1.000).Multivariate logistic regression analysis showed that the use of more than one stent(OR=6.63,95％CI=1.10-39.88,P=0.039)and the difference between the distal parent artery diameter and the stent diameter(Dd)(OR=7.00,95％CI=1.4-35.7,P=0.019)were the independent risk factors for procedure-related complications.The area under the receiver operating characteristic curve(AUC)of the receiver operating characteristic curve(ROC)for distal parent artery Dd was 0.854(95％CI=0.746-0.963).Conclusion For the treatment of large or giant intracranial aneurysms,FAC is clinically safe and effective.The mid-term follow-up aneurysm occlusion rate of FAC is higher than that of simple FD treatment.The use of more than one stent and the distal parent artery Dd are the independent risk factors for procedure-related complications in the treatment of large or giant intracranial aneurysms with FD.

Objective To construct the training program for the digital and intelligent capabilities of specialized nurses in the Central Sterile Supply Department(CSSD),and conduct preliminary practice to provide talent support for the intelligent development of CSSD.Methods From February to April 2024,based on the core technologies of digital intelligence and related core capabilities,a training program for digital intelligence-related competencies of CSSD specialized nurses was constructed using literature review and the Delphi expert consultation method.From July to August 2024,the program was initially implemented in the training of CSSD specialized nurses.The nurses'information competency before and after the training was compared,and the nurses' satisfaction with the digital intelligence-related training program was assessed.Results This study conducted 2 rounds of expert consultation via questionnaire.The effective recovery rate of the questionnaires in both rounds was 100％.The expert authority coefficients were 0.790 and 0.800,respectively,and the variation coefficients ranged from 0 to 0.229 and 0 to 0.105.Ultimately,a training program for the digital-related competencies of CSSD specialty nurses was established,which includes 4 components:training objectives,training content,training methods,and assessment methods.Specifically,there were 3 indicators at the first level and 14 at the second level for training objectives,6 indicators at the first level and 32 at the second level for training content,and 6 indicators at the first level for training methods and assessment methods.After the implementation of the training program,the information competency of the nurses in all dimensions and the total score were significantly higher than those before training(P＜0.05).Moreover,the average scores for the training content,training methods,and assessment methods were all above 3 points,indicating a high overall satisfaction among the nurses.Conclusion The construction process of the training program for the digital and intelligent capabilities of CSSD specialty nurses is scientific and reliable.The content is highly practical and distinctive in its specialty.The training methods and assessment approaches are diverse.This program can enhance nurses' information competency and provide a reference for the implementation of digital and intelligent training for CSSD specialty nurses.

Objective:To explore the status quo of fertility information need of breast cancer patients at childbearing age, and analyze its influencing factors.Methods:From April to October 2023, 400 cases of breast cancer patients of childbearing age in two Class Ⅲ Grade A hospitals in Zhengzhou City were selected by convenience sampling. Patents were investigated with the General Information Questionnaire and the Fertility Information Needs Assessment Questionnaire for Breast Cancer Patients of Childbearing Age. Multiple linear regression was used to analyze the influencing factors of fertility information need of breast cancer patients of childbearing age. A total of 400 questionnaires were distributed, and 385 valid questionnaires were collected, with an effective response rate of 96.25% (385/400) .Results:The 385 breast cancer patients of childbearing age had a high level of need for fertility information with an average score of items (3.17±0.73). The scores for each dimension in descending order of the mean score of items were disease impact information, treatment impact information, psychosocial information, fertility management information, sexual health information, and fertility protection information. Age, marital status, education level, per capita monthly family income and duration of illness were the factors influencing the fertility information need ( P<0.05) . Conclusions:Breast cancer patients of childbearing age have a high level of need for fertility information, and their need is influenced by a number of factors. Medical and nursing staff should improve the fertility information support program based on the real needs of breast cancer patients, and provide personalized fertility information support for breast cancer patients of childbearing age with different characteristics.