Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.

This paper summarized Professor ZHANG Farong's experience in the staged treatment of hyperthyroi-dism with triangular medicine. It is considered that "pathogenic heat consuming and damaging qi-yin" is the key pathogenesis of hyperthyroidism. In the early stage， liver constraint transforms into fire， and then pathogenic heat becomes exuberant inside， consuming qi and damaging yin. In the middle stage， the fire and heat are intense， and phlegm and stasis are binded， when qi and yin are initially depleted. In the late stage， both qi and yin are deficient， and as the disease lasts for a long time， the kidneys are affected， resulting in liver and kidney depletion. For treatment， it is suggested to put focus on rectifying healthy qi and dispelling pathogen， protecting qi and yin， and treating the disease by stages based on syndrome differentiation， and eight groups of triangular medicines have been summarized according to the characteristics of pathogenesis in different periods. In the early stage， the combination of Chaihu （Radix Bupleuri）， Xiangfu （Rhizoma Cyperi） and Yujin （Radix Curcumae） is used to soothe the liver and resolve constraint， and the combination of Longdancao （Radix et Rhizoma Gentianae）， Huangqin （Radix Scutellariae） and Zhizi （Fructus Gardeniae） is recommended to clear liver and drain fire. In the middle stage， the combination of Xiakucao （Spica Prunellae）， Baihua Sheshecao （Herba Hedyotis Diffusae） and Banzhilian （Herba Scutellariae Barbatae） is used to clear heat and dissipate masses， and the combination of Huangyaozi （Rhizoma Dioscoreae bulbiferae）， Maozhuacao （Ranunculus Ternatus） and Shancigu （Asarum Sagittarioides） can dissolve phlegm and dissipate masses， and the combination of Danshen （Radix et Rhizoma Salviae Miltiorrhizae）， Xuanshen （Radix Scrophulariae） and Kushen （Radix Sophorae Flavescentis） can invigorate blood and eliminate goiter. In the late stage， the combination of Dangshen （Radix Codonopsis）， Baizhu （Rhizoma Atractylodis Macrocephalae） and Yiyiren （Semen Coicis） can fortify spleen and replenish qi， and the combination of Maidong （Radix Ophiopogonis）， Beishashen （Radix Glehniae） and Wuweizi （Fructus Schisandrae Chinensis） is used to nourish yin and calm heart， while the combination of Huangqi （Radix Astragali）， Huangjing （Rhizoma Polygonati） and Diyu （Radix Sanguisorbae） is used to nourish yin and replenish kidneys.

Objective:To investigate the regulatory effect of transient receptor potential cation channel subfamily C member 3 (TRPC3) on the retina in oxygen-induced retinopathy (OIR) mice and biological behavior of human retinal vascular endothelial cells (HREC).Methods:A total of 32 healthy SPF grade 7-day-old C57BL/6 mice were selected and randomly divided into a control group and an OIR group by the random number table method, with 16 mice in each group.The control group received no special treatment, and the OIR model was established in the OIR group.On postnatal day 17 (PN17), the success of the model establishment was verified by immunofluorescence staining of the retinal patch.The in vitro cultured HREC were divided into a normal control group, a transfection reagent group, and a si-TRPC3 group.The normal control group received no special treatment, while the transfection reagent group and the si-TRPC3 group were transfected with transfection reagent or transfection reagent + si-TRPC3.The relative expression of TRPC3 mRNA was detected by real-time quantitative fluorescence PCR.The relative expressions of TRPC3, transcription factor NF-E2 related factor (Nrf2), and superoxide dismutase (SOD) proteins were determined by Western blot.HREC were further divided into a normal control group, a vascular endothelial growth factor (VEGF) group, a si-TRPC3 group, and a Pyr3 (TRPC3 channel inhibitor) group, which were cultured in complete medium, medium containing 20 ng/ml VEGF recombinant protein, medium containing 20 ng/ml VEGF recombinant protein (si-TRPC3 transfection for 72 hours), and medium containing 20 ng/ml VEGF recombinant protein+ 1 μmol/L Pyr3 for 48 hours, respectively.The proliferation ability of HREC was detected using cell counting kit 8 (CCK-8). The horizontal and vertical migration ability of cells were detected by cell scratch assay and transwell assay, respectively.This study followed the 3R principles of animal welfare and was approved by the Ethics Committee of Hebei Eye Hospital (No.2023LW04). Results:Pathological neovascular clusters with strong fluorescent staining appeared in the retina of OIR mice on PN17.The relative expressions of TRPC3 mRNA and protein in the retina of OIR mice were 2.057±0.244 and 1.517±0.290, respectively, significantly higher than 0.983±0.033 and 0.874±0.052 of control group ( t=6.165, 3.094; both at P<0.05). The relative expression levels of TRPC3 mRNA and protein were significantly lower, and the relative expression levels of Nrf2 and SOD proteins were higher in the si-TRPC3 group than in the normal control and transfection reagent groups, and the differences were statistically significant (all at P<0.05). The CCK-8 experiment results showed that the cell absorbance value was higher in the VEGF group than in the normal control group, and lower in the si-TRPC3 and Pyr3 groups than in the VEGF group, with statistically significant differences (all at P<0.05). The results of the cell scratch experiment showed that the lateral migration rate of VEGF group cells was higher than that of normal control group, while the lateral migration rate of si-TRPC3 group and Pyr3 group cells was lower than that of VEGF group, and the differences were statistically significant (all at P<0.05). The transwell experiment results showed that the number of stained cells in the VEGF group was higher than that in the normal control group, and the number of stained cells in the si-TRPC3 group and Pyr3 group was lower than that in the VEGF group, with statistically significant differences (all at P<0.05). Conclusions:Hypoxia induces increased TRPC3 expression in OIR mouse retina, and downregulation of TRPC3 inhibits HREC proliferation and migration.The mechanism is related to the activation of the Nrf2-related oxidative stress pathway.

Objective To investigate the ocular biological parameters of children with idiopathic short stature(ISS)and compare them with those of children with growth hormone deficiency(GHD)and normal children,and to explore the characteristics of ocular biological parameters in this group,so as to provide a reference for the screening of visual acuity and the safety of growth hormone therapy in children with ISS.Methods A total of 15 children aged 5-14 years old with ISS were selected as the observation group,32 children with GHD were selected as the control group,and 47 children of normal height who underwent routine visual acuity screening were selected as normal controls.The ocular biological parameters of children with ISS were studied.The differences of vision-re-lated parameters between the above three groups were compared.The influencing factors affecting the visual devel-opment of children with ISS were analyzed.Results The axial ratio of ISS was significantly higher than that of the GHD group and normal children,and the intraocular pressure of the ISS group was significantly higher than that of the GHD group and normal children.There was no significant difference in axial length between the ISS group and the GHD group,as well as normal children(P＞0.05),but the axial length of the GHD group was significantly shorter than that of normal children.The corneal curvature of ISS was significantly greater than that of normal chil-dren.The axial rate ratio of the ISS group was positively correlated with the peak value and corneal curvature of growth hormone provocation test(β=1.052,P＜0.05;β=0.004,P＜0.05).Conclusion Children with ISS may have high intraocular pressure and high risk of myopia.Higher peak results of growth hormone provocation test and large corneal curvature may be the risk factors for myopia.

Objective:To determine incidence of seasonal influenza virus infection in the community and to analyze the factors influencing seasonal influenza virus infection.Methods:This study recruited residents aged 6-59 years to build a cohort in 15 villages/streets in Macheng city in November 2019. Meanwhile, a cross-sectional baseline survey was conducted immediately to collect sera, information on demographics and child protection knowledge, behaviors, as well as attitudes using a questionnaire from the participants enrolled in the cohort (i.e., before the influenza epidemic season). In July 2020, a cross-sectional follow-up survey was conducted to collect sera once again (i.e., after the influenza season). Paired sera from the two cross-sectional surveys were tested for influenza virus-specific antibodies by hemagglutination inhibition (HI) test or micro-neutralization (MN) test using a circulating representative strain of each subtype/lineage of influenza virus as the test antigen. The infections with influenza virus subtype/lineage was confirmed if there was a four-fold or more increase in titers of antibodies against circulating representative strain of the subtype/lineage of influenza virus. Factors influencing infection with influenza A (H3N2) and B/Victoria viruses were analyzed using univariable and multivariable logistic regression.Results:In November 2019, 800 study participants were enrolled in the cohort, including 340 children aged 6-17 years and 460 adults aged 18-59 years; 605 study participants (including 224 children and 381 adults) were followed up in July 2020 and their paired sera were obtained before and after the influenza season. 25.3% (153/605) of the participants were confirmed to be infected with at least one subtype/lineage of seasonal influenza virus by HI and MN tests. The overall incidence of influenza viruses of all subtypes/lineages in children was 44.2% (95% CI: 37.6%-50.8%) which was significantly higher than the incidence of 14.1% in adults (95% CI: 10.7%-17.7%). Children had the highest incidence of influenza A (H3N2) virus infection, followed by B/Victoria. MN or HI antibody titers in A (H3N2)[ OR=0.88 (95% CI: 0.84-0.93)] and B/Victoria[ OR=0.97 (95% CI: 0.95-0.99)] before the influenza season were significantly associated with whether children were infected with that subtype/lineage of influenza virus. Conclusions:The residents aged 6-59 years in Macheng city had a substantial incidence of seasonal influenza virus infection during the influenza season from winter 2019 to spring 2020. Notably, almost half of children aged 6-17 years have been infected with seasonal influenza virus. Higher titers of HI/MN antibodies against seasonal influenza virus before the influenza season would be likely to reduce the risk of infection with influenza A (H3N2) and B/Victoria.

AIM: To evaluate the effect of capsular tension ring(CTR)on the stability and accuracy of Barrett universal Ⅱ intraocular lens(IOL)calculation formula in patients with high myopia and cataract.METHODS:Prospective study. A total of 40 cases(80 eyes)of high myopia and cataract that visited our hospital from January to June 2022 were selected. The patients were divided into CTR group and blank group by random number table method, with 40 eyes in each group. All patients were measured by IOL Master, and the actual implanted IOL power and predicted postoperative power were calculated according to Barrett universal Ⅱ formula. The uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA)at 6 mo after surgery were recorded, and the mean absolute error(MAE)was compared at 6 mo after surgery. Furthermore, the stability of postoperative refractive status and the relationship between the predicted postoperative diopter and CTR were evaluated.RESULTS:The UCVA and BCVA of the two groups were improved at 6 mo after operation(P>0.05), and there was no significant difference in UCVA and BCVA between the two groups at each time point(all P>0.05). After the implantation of IOL in 80 eyes based on the Barrett universal Ⅱ formula, the predicted postoperative diopter was -2.01±0.71 D, the actual postoperative diopter was -1.64±0.88 D, and the MAE was 0.37±0.98 D in the CTR group; in the blank group, the predicted diopter was -2.12±0.64 D, the actual diopter was -1.54±0.88 D, and the MAE was 0.58±0.31 D. The difference between the two groups was statistically significant(P<0.05). According to the axial length, CTR implantation can effectively reduce refractive error for any axial length(P>0.05). With the grouth of axial length, the MAE value increased. The postoperative MAE value of patients with axial length ≥30 mm was statistically different between the two groups(P<0.05).The proportion of hyperopic drift was 18%(7/40)in the CTR group and 30%(12/40)in the blank group, respectively, with a significant difference between the two groups(P<0.05).CONCLUSION: For patients with high myopia and cataract, the Barrett universal Ⅱ formula has high accuracy in predicting postoperative diopter. Intraoperative implantation of CTR can not only maintain the shape of the capsule bag, effectively prevent the intraoperative rupture of the suspensory ligament of the lens and make the IOL more neutral, but also is conducive to the early stability of postoperative diopter of cataract patients. It also provides more stable refractive results and reduces refractive drift. For myopic patients considering CTR implantation, it is recommended to increase the preoperative reserve diopter of -0.50 D to achieve the ideal refractive state.

Objective To investigate the effect of different sizes of capsular tension ring(CTR)on the stability of the capsular bag of patients with high myopia accompanied by cataract after surgery.Methods In this prospective study,75 patients(150 eyes)with high myopia and cataract visited our hospital from January 2022 to June 2022 were selected.These patients were divided into the large-size group,small-size group and control group using the random number table,with 25 patients(50 eyes)in each group.All affected eyes underwent phacoemulsification combined with intraocular lens(IOL)implantation.CTR1311(with an open diameter of 13mm)was implanted in patients of the large-size group,CTR1210(with an open diameter of 12mm)was implanted in patients of the small-size group,and no CTR was implanted in patients of the control group.The uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),intraocular pressure(IOP),corneal endothelial cell density(ECD),effective lens position(ELP),mean absolute refractive error,an-terior capsular area and complications of patients in the three groups were compared before,1 month,3 months,6 months and 1 year after the surgery.Results One year after the surgery,the UCVA and BCVA of patients in the three groups im-proved than those before surgery(all P＜0.05),and the IOP and corneal ECD had no significant difference from those be-fore surgery(all P＞0.05).At different times after the surgery,the IOL tilt in patients who underwent CTR implantation was significantly lower than that of patients in the control group(all P＜0.05),and the IOL tilt in the small-size group was higher than that in the large-size group(all P＜0.05);the IOL eccentricity in patients of the three groups had no significant difference(all P＞0.05).At 6 months after the surgery,the postoperative IOL eccentricity and tilt of patients with an axial length＞30 mm in the large-size group were smaller than those of patients in the small-size group(both P＜0.05).At dif-ferent times after the surgery,the anterior capsular area of patients in the control group was significantly smaller than that of the large-size group and small-size group(all P＜0.05),and there was no significant difference in the anterior capsular area between the large-size group and small-size group(all P＞0.05).At 6 months after the surgery,the mean absolute re-fractive error of patients in the control group was greater than that of the large-size group and small-size group(both P＜0.05),and there was no significant difference in the mean absolute refractive error between the large-size group and small-size group(P＞0.05).During the 1-year follow-up,there were no severe complications in the three groups.Conclusion Phacoemulsification combined with CTR implantation is effective for patients with high myopia and cataract.The postop-erative IOL of patients who received large-size CTR implantation is more stable than that of patients who underwent small-size CTR implantation.For patients with an axial length＞30mm,large-size CTR implantation is recommended.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Objective To investigate the expression level and clinical application value of serum resistin in patients with systemic lu-pus erythematosus(SLE).Methods Forty-five SLE patients visited Nanjing Drum Tower Hospital,Clinical College of Nanjing Uni-versity of Chinese Medicine from January to August 2023 were enrolled in the study.The patients were scored and grouped according to the SLE disease activity index(SLEDAI),with SLEDAI＜9 score in the inactive group(n=32)and SLEDAI≥9 score in the active group(n=13).Thirty-four healthy individuals who underwent physical examination in our hospital were recruited as healthy controls.The clinical data and laboratory related indicators such as urine protein and serum complement C3 levels were collected from SLE pa-tients and healthy controls.Serum resistin levels were detected by enzyme-linked immunosorbent assay(ELISA).The clinical screening value of serum resistin for SLE was evaluated with the receiver operating characteristic(ROC)curve.The correlations of serum resistin levels with different laboratory indicators were determined by Pearson correlation analysis.Results The serum resistin levels in SLE patients([7.64±0.64]ng/mL)were significantly higher than that in healthy controls([2.56±0.43]ng/mL),and the difference was statistically significant(t=6.195,P＜0.01).The serum resistin levels in active SLE patients([10.10±1.45]ng/mL)were significant-ly higher than that in inactive SLE patients([6.64±0.60]ng/mL),and the difference was statistically significant(t=2.632,P＜0.05).The area under the ROC curve(AUCROC)of serum resistin for screening SLE was 0.897.When the cut-off value was 5.893 ng/mL,the sensitivity was 86.67%and the specificity was 82.35%.The serum resistin level in SLE patients was positively correlated with urine protein(r=0.692,P＜0.01),while negatively correlated with serum complement C3(r=-0.354,P＜0.05).Conclusion The expression levels of serum resistin in SLE patients are significantly increased and positively correlated with SLE disease activity and urine protein.Serum resistin may become a novel biomarker for the diagnosis and therapeutic effect assessment of SLE.

Objective:To explore the influencing factors and effectiveness of community follow-up in patients with cardiac implantable electronic device (CIED) implantation.Method:A total of 132 patients who received CIED implantation in the Department of Cardiology of Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2021 to February 2022 were enrolled in this prospective cohort study. Among them 33 patients were followed up in community health service centers associated with Tongren Hospital (community follow-up group) and 99 matched patients were followed up in the CIED outpatient clinic of the hospital (outpatient follow-up group) with a ratio of 1∶3. The clinical data of the selected patients were collected through a questionnaire survey; the follow-up data were extracted through the CarelinkExpress electronic follow-up platform and the CIED outpatient information system of Tongren Hospital. Adjustment of the treatment protocol or CIED parameters at follow-up, and the referral from the community health service centers were defined as visit with-an-action (VWA). The endpoint of follow-up was the occurrence of major adverse events. The multivariate logistic regression model was used to analyze the factors influencing patient selection for community follow-up.Results:The univariate analysis showed that the frequency of visits to community health service centers and the service contracting rate in community follow-up group were higher than those of outpatient follow-up group ( P<0.05). The multivariate logistic regression analysis showed that the contracted community physician service was an independent influencing factor of patient choosing community follow-up ( OR=2.143, 95% CI: 1.103-4.166, P=0.025). A total of 469 visits of followed up occurred in 132 patients, including 45 community visits and 424 outpatient visits. VWA accounted for 22.2% (10/45) in the community follow-up group, and 17.2% (73/424) in the outpatient follow-up group ( P>0.05). There was no significant difference in the safety and effectiveness indicators (VWA, major adverse events, and unplanned follow-up) between the two groups ( P>0.05). More patients in the community follow-up group walked to the hospital than the outpatient follow-up group ( P<0.05);and the main transportation for the later was by bus or taxi(42(42.4%)or 41(41.4%)). The average waiting time in the community follow-up group was significantly shorter than that in outpatient follow-up group ( P<0.05). The total time required for a single follow-up in the community follow-up group was 50.0 (45.0, 59.5) minutes, which was significantly shorter than that in the routine outpatient follow-up group (107.0 (90.0, 135.0) minutes, P<0.05). Conclusions:The contracting with community physicians is an independent influencing factor for CIED implanted patients to choose community follow-up. The safety and effectiveness of community follow-up are comparable to routine outpatient follow-up, and community follow-up is more convenient.