ObjectiveTo analyze the effect of standardized training on post competency of rehabilitation therapists, based on World Health Organization rehabilitation competency framework (RCF), and combined with the characteristics of rehabilitation and the requirements of standardized training in China. MethodsFrom 2018 to 2022, a total of 30 rehabilitation therapists who participated in the standardized training were selected. Before and after the standardized training, the closed-book theoretical assessment and Mini-clinical Evaluation Exercise (Mini-CEX) assessment were carried out, and a 360-Degree Evaluation scale was distributed to their teachers, peers and patients. Through multi-dimensional post competency analysis, the data obtained from the scales were combined with the five dimensions of basic theoretical knowledge, clinical practice ability, medical humanities literacy, scientific research and teaching ability, and organizational management ability to analyze the effect of standardized training on post competency of rehabilitation therapists. ResultsAfter training, the therapists improved in theory and case analysis (Z > 2.716, P < 0.05). They also improved in medical interview skills, physical examination, humane care/professionalism, clinical judgment ability and overall clinical level (Z > 2.162, P < 0.05) according to Mini-CEX. The medical ethics, daily work, management ability, social ability, interpersonal communication ability, basic professional ability and operation ability improved (Z > 1.978, P < 0.05) according to the 360-Degree Evaluation scale. The effect of standardized training was significant in basic theoretical knowledge, clinical practice ability and medical humanities literacy by the post competency analysis model. ConclusionThe effect of standardized training of rehabilitation therapists is significant, and the therapists can be competent for daily work in diagnosis and treatment after training.

ObjectiveTo compare the effect of proprioceptive neuromuscular training methods on pain and motor ability of knee in patients with early knee osteoarthritis (KOA) . MethodsFrom November, 2022 to May, 2023, 60 early KOA patients from Beijing Bo'ai Hospital and community were randomly divided into groups A, B and C, with 20 patients in each group. Group A received proprioceptive neuromuscular facilitation (PNF), group B received neuromuscular exercise (NEMEX), and group C received PNF and NEMEX, for six weeks. They were assessed with Visual Analogue Scale for pain (VAS), angle reappearance test, difference of pre-motor reaction time (VM-VL), active range of motion (AROM) of knee flexion, 10-meter walk test (10MWT), and Knee Injury and Osteoarthritis Outcome Score (KOOS) before and after treatment. ResultsAll the indexes improved in all the groups after treatment (|t| > 2.532, P < 0.05). Among the groups, the VAS score was the least in group A, and then groups C and B; the angle reappearance error was the least in group C, and similar in groups A and B; the VM-VL was the least in groups A and C, followed by group B. ConclusionPNF, NEMEX and PNF+NEMEX can relieve the pain and improve the motor function of knee in patients with early KOA, however, PNF is the most effective on relieving pain, and PNF+NEMEX is the most effective on improving knee function.

ObjectiveTo observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA. MethodsFrom January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique. ResultsCompared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P < 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P < 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t = 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA. ConclusionThe thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.

OBJECTIVE: To analyze the risk factors of in-hospital death in patients with sepsis in the intensive care unit (ICU) based on machine learning, and to construct a predictive model, and to explore the predictive value of the predictive model. METHODS: The clinical data of patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to April 2021 were retrospectively analyzed,including demographic information, vital signs, complications, laboratory examination indicators, diagnosis, treatment, etc. Patients were divided into death group and survival group according to whether in-hospital death occurred. The cases in the dataset (70%) were randomly selected as the training set for building the model, and the remaining 30% of the cases were used as the validation set. Based on seven machine learning models including logistic regression (LR), K-nearest neighbor (KNN), support vector machine (SVM), decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost) and artificial neural network (ANN), a prediction model for in-hospital mortality of sepsis patients was constructed. The receiver operator characteristic curve (ROC curve), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive performance of the seven models from the aspects of identification, calibration and clinical application, respectively. In addition, the predictive model based on machine learning was compared with the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) models. RESULTS: A total of 741 patients with sepsis were included, of which 390 were discharged after improvement, 351 died in hospital, and the in-hospital mortality was 47.4%. There were significant differences in gender, age, APACHE II score, SOFA score, Glasgow coma score (GCS), heart rate, oxygen index (PaO₂/FiO₂), mechanical ventilation ratio, mechanical ventilation time, proportion of norepinephrine (NE) used, maximum NE, lactic acid (Lac), activated partial thromboplastin time (APTT), albumin (ALB), serum creatinine (SCr), blood urea nitrogen (BUN), blood uric acid (BUA), pH value, base excess (BE), and K⁺ between the death group and the survival group. ROC curve analysis showed that the area under the curve (AUC) of RF, XGBoost, LR, ANN, DT, SVM, KNN models, SOFA score, and APACHE II score for predicting in-hospital mortality of sepsis patients were 0.871, 0.846, 0.751, 0.747, 0.677, 0.657, 0.555, 0.749 and 0.760, respectively. Among all the models, the RF model had the highest precision (0.750), accuracy (0.785), recall (0.773), and F1 score (0.761), and best discrimination. The calibration curve showed that the RF model performed best among the seven machine learning models. DCA curve showed that the RF model exhibited greater net benefit as well as threshold probability compared to other models, indicating that the RF model was the best model with good clinical utility. CONCLUSIONS The machine learning model can be used as a reliable tool for predicting in-hospital mortality in sepsis patients. RF models has the best predictive performance, which is helpful for clinicians to identify high-risk patients and implement early intervention to reduce mortality.
Humans ; Hospital Mortality ; Retrospective Studies ; ROC Curve ; Prognosis ; Sepsis/diagnosis* ; Intensive Care Units

Objective To compare the effects of Flexi-bar training in different exercise patterns on trunk stability muscles.Methods From June, 2020 to January, 2021, 21 healthy men in Beijing Bo'ai Hospital finished Flexi-bar exercise in seven patterns in random order, namely no vibration, two hands-front vibration, dominant hand-front vibration, non dominant hand-front vibration, two hands-up vibration, two hands-down vibration and two hands-back vibration. The average voltage of electromyography of upper trapezius, middle trapezius, lower trapezius, latissimus dorsi and lumbar multifidus were recorded with surface electromyography during seven kinds of Flexi-bar exercise.Results The average voltage of lumbar multifidus was the most as two hands-front vibration (F=42.362, P<0.001); however, it was the most for upper trapezius and lower trapezius as two hands-up vibration (F > 10.935, P<0.001), it was the most for latissimus dorsi as two hands-back vibration (F=35.243, P<0.001), and it was the most for ipsilateral middle trapezius as non dominant hand-front vibration (F=40.400, P<0.001).Conclusion Flexi-bar training can effectively activate the contraction of trunk stability muscles, and it can be optimized in targeted patterns.

Objective:To evaluate the diagnostic value of HPV detection in squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site.Methods:Clinical data of 6 patients who were initially diagnosed with squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site and eventually diagnosed with HPV-related oropharyngeal squamous cell carcinoma were collected, and the process of diagnosis was analyzed.Results:Upon the initial admission, all patients were diagnosed with squamous cell carcinoma of the cervical lymph node metastasis with positive p16 expression, positive HPV-16 subtype and negative EBER expression. No obvious primary lesion was found after comprehensive examination. Subsequently, four of them underwent ipsilateral tonsollar blind biopsy ( n=2) and ipsilateral tonsillectomy ( n=2). All these four patients were pathologically diagnosed with tonsillar squamous cell carcinoma. For the other two cases, MRI detected the thickening complicated with enhancement of ipsilateral wall of oropharynx and tongue root after follow-up for D149 and D545 , respectively. Biopsy confirmed the diagnosis of squamous cell carcinoma of the tonsil and tongue root, respectively. Conclusion:For patients with HPV-positive squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site, the possibility that the primary lesion originates from the oropharyngeal site, especially the tonsil and tongue root, should be highly suspected.

Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.

Objective To observe the clinical effect of calcitonin(PCT) in the identification of bacterial infection and viral infection.Methods 150 cases were randomly selected,including 50 cases of viral infection,100 cases of bacterial infection.The people with physical examination at the same period in the hospital whose peripheral blood culture were negative were selected as control group.PCT concentrations of various bacterial infections were observed,as well as the concentrations of PCT in various viral infections,and compared with the control group.Results The PCT level in the bacterial infection group was (8.023±3.542)ng/mL, which was significantly higher than (0.031±0.011)ng/mL in the control group(t=15.960,P=0.000).There was no significant difference in the level of PCT between the viral infection group [(0.032±0.008)ng/mL] and the control group [(0.031±0.011) ng/mL] (t=1.903,P=0.059).In different bacterial infections,the PCT level in sepsis was the highest [(17.544±4.511)ng/mL],followed by bacterial peritonitis and infectious pancreatitis[(5.131±1.231)ng/mL,(4.941±1.665)ng/mL].The PCT level of cellulitis was the lowest [(27.544±4.511)ng/mL].Of a variety of viral infections,the patients with EB virus infection had slightly higher PCT level[(0.027±0.002)ng/mL],which of measles virus infection was slightly lower[(0.021±0.002)ng/mL],the overall PCT level had no significant difference.Conclusion It is important to identify the bacterial infection and viral infection, which can provide a reliable basis for clinical treatment.

Objective To investigate the influence of probiotics assisted with routine antibiotic regimens on the short-term clinical efficacy,mucosal barrier function and inflammatory response of patients with bacterial peritonitis secondary to liver cirrhosis.Methods 60 patients with bacterial peritonitis secondary to liver cirrhosis were chosen,and they were randomly divided into two groups according to the digital table,each group in 30 cases.The control group received routine antibiotic regimens alone,and the observation group were given probiotics on the basis of the control group.The short-term clinical efficacy,the levels of DAO,D-Lac and ET before and after treatment of the two groups were compared.Results The short-term effective rates of the control group and observation group were 70.00％,96.67％,respectively.The short-term effective rate of the observation group was significantly higher than that of control group(x2 =9.14,P ＜0.05).After treatment,the levels of DAO of the control group and observation group were (4.33 ± 0.79) U/mL,(2.19 ± 0.47) U/mL,respectively.The levels of D-Lac of the control group and observation group after treatment were (15.88 ± 1.95) U/mL,(8.57 ± 1.03) U/mL,respectively.The levels of DAO and D-Lac of the observation group after treatment were significantly lower than those of the control group and before treatment(t =2.78,3.06;3.44,3.78,3.61,4.10,all P ＜ 0.05).The levels of ET of the control group and observation group after treatment were (0.09 ± 0.02) EU/mL,(0.04 ± 0.01) EU/mL,respectively.The level of ET of the observation group after treatment was significantly lower than that of the control group and before treatment(t =2.49,3.01,3.46,all P ＜ 0.05).Conclusion Probiotics assisted with routine antibiotic regimens in the treatment of patients with bacterial peritonitis secondary to liver cirrhosis can effectively relieve the symptoms and signs,improve the mucosal barrier function and is helpful to reduce the inflammatory response.

Objective To explore the application value of color Doppler ultrasound in screening of fetal con-genital heart disease and its significance.Methods 4 132 cases of the expectant mothers were selected,using color Doppler ultrasonography on the line screening of five section to detect fetal cardiac,to compare with the actual clinical situation and analyze the occurrence of fetal congenital heart disease.Results Among 50 cases(1.21%) of congeni-tal heart disease,28 cases were live births, accounted for 56.00%,13 cases of induced abortion, accounted for 26.00%,9 cases died,accounted for 18.00%.48 cases were detected by ultrasound,relevance ratio was 1.16%,the accuracy rate was 96.00%,the missed diagnosis rate was 4.00%.28 cases of live births undergoing surgical correc-tion,treatment effect was good,48 cases were detected,including 10 cases of ventricular septal defect,6 cases of tetral-ogy of Fallot,6 cases of atrial septal defect,5 cases of endocardial cushion defect,4 cases of single chamber,4 cases of persistent truncus arteriosus,3 cases right ventricular dysplasia,3 cases of tricuspid valve shift malformation,2 cases of persistent left superior vena cava,2 cases left ventricular dysplasia,2 cases of aortic arch interruption,1 case of rhabdomyoma.Conclusion Using color Doppler ultrasound detection for pregnant women can effectively detect severe congenital heart disease in the fetus,stop gravid timely,which can effectively improve the level of prenatal and postnatal care that is worth clinical application.