Objective: To analyze the prevalence and related factors of pediatric flexible flatfoot (PFF) among 7-8 year old children in Changzhou, so as to provide a feasible basis for the prevention and treatment of PFF. Methods: From December 2023 to February 2024, a total of 1 685 children aged 7-8 from 10 primary schools in Changzhou were selected by stratified cluster random sampling method, and screened for PFF by using a foot optical assessment recording device. Information including sex, body mass index (BMI), diet, exercise and shoe wearing habits were collected. The valgus angle of the hindfoot was measured on the body surface by using an orthopedic measuring ruler in the standing position. Pain levels were evaluated by using visual analogue score (VAS) for children with flatfoot syndrome. Multivariate Logistic analysis was used to analyze related factors of PFF. Results: The overall detection rate of PFF was 27.4%, and there was a significant difference in the detection rate of PFF between boys and girls, with 30.3% and 24.1% respectively ( χ 2=7.96, P < 0.01 ). Most cases of PFF were mild flatfoot (60.8%) and bilateral ( 60.4% ). Approximately 13.2% of children with PFF had flatfoot syndrome, with a mean VAS of (2.86±0.73). About 56.1% of children with PFF had a normal valgus angle of the hindfoot. Sex, high BMI and preference for shoe last with front upturned shoe shape were positively correlated with the detection of PFF ( OR= 1.74, 1.54, 1.13, P <0.05). After stratified by sex, regular exercise in boys and age in girls were negatively correlated with the detection of PFF ( OR=0.40, 0.64, P <0.05). Conclusions The detection rate of PFF in 7-8 year old children is high. Additionally, PFF combined with flatfoot syndrome or valgus hindfoot is relatively rare and is likely to be underestimated, which emphasizes the importance of early detection and intervention for PFF.

Objective:To retrospectively analyze the clinical and pathologic characteristics, response to treatment, survival, and prognosis of patients with primary large B-cell lymphoma of the central nervous system (PCNSLBCL) .Methods:Clinical and pathologic data of 70 patients with PCNSLBCL admitted to Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2010 to November 2022 were collected for retrospective analysis. Survival analysis was performed using the Kaplan-Meier method and log-rank test, and prognosis analysis was conducted using the Cox proportional hazards model.Results:Among 70 patients with PCNSLBCL, complete remission (CRs) were achieved in 49 (70.0% ) and partial remission in 4 (5.7% ) after the first-line induction therapy; the overall remission rate was 75.7%. The 2-year progression-free survival (PFS) rate was 55.8% and the median progression-free survival (mPFS) time was 35.9 months, whereas the 2-year overall survival (OS) rate was 79.1% with a median OS time not reached. After CR induced by first-line therapy, cumulative incidence of relapse (CIR) was lower in patients who had received auto-HSCT than in those who had not received consolidation therapy ( P=0.032), whose 2-year PFS rate was 54.4% and mPFS time was 35.9 months; comparatively, the 2-year PFS rate in patients having received oral maintenance of small molecule drugs reached 84.4% with a mPFS time of 79.5 months ( P=0.038). Multivariant analysis demonstrated that Class 3 in the Memorial Sloan-Kettering Cancer Center (MSKCC) prognostic model is an independent adverse prognostic factor of OS in patients with PCNSLBCL ( HR=3.127, 95% CI 1.057-9.253, P=0.039) . Conclusions:In patients with PCNSLBCL achieving CR after the first-line induction therapy, auto-HSCT as consolidation therapy would lead to a decreased CIR, and PFS time could be prolonged by oral maintenance of small molecule drugs. Class 3 MSKCC prognostic model is independently associated with poorer OS.

Background::Genetic variants of dopaminergic transcription factor-encoding genes are suggested to be Parkinson’s disease (PD) risk factors; however, no comprehensive analyses of these genes in patients with PD have been undertaken. Therefore, we aimed to genetically analyze 16 dopaminergic transcription factor genes in Chinese patients with PD.Methods::Whole-exome sequencing (WES) was performed using a Chinese cohort comprising 1917 unrelated patients with familial or sporadic early-onset PD and 1652 controls. Additionally, whole-genome sequencing (WGS) was performed using another Chinese cohort comprising 1962 unrelated patients with sporadic late-onset PD and 1279 controls.Results::We detected 308 rare and 208 rare protein-altering variants in the WES and WGS cohorts, respectively. Gene-based association analyses of rare variants suggested that MSX1 is enriched in sporadic late-onset PD. However, the significance did not pass the Bonferroni correction. Meanwhile, 72 and 1730 common variants were found in the WES and WGS cohorts, respectively. Unfortunately, single-variant logistic association analyses did not identify significant associations between common variants and PD. Conclusions::Variants of 16 typical dopaminergic transcription factors might not be major genetic risk factors for PD in Chinese patients. However, we highlight the complexity of PD and the need for extensive research elucidating its etiology.

Objective:To explore the risk factors for stone recurrence after laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) and to develop a risk prediction model.Methods:Clinical data of 344 patients with bile duct stones who underwent LCBDE combined with LC at Hebei General Hospital from January 2016 to March 2022 were retrospectively analyzed, including 165 males and 179 females, aged (62.72±13.56) years old. Patients were divided into two groups based on whether stones recurred during the follow-up period: recurrence group ( n=37) and non-recurrence group ( n=307). Clinical data such as common bile duct diameter, stone size, number of stones and duration of T-tube drainage were collected from the patients. Logistic regression was used to analyze the risk factors for postoperative stone recurrence, and then developed a logistic regression model. The predictive efficacy of the model was assessed by the area under the receiver operating characteristic (ROC) curve, and the Hosmer-Lemeshow test. Results:The results of multifactorial logistic regression analysis showed that patients with ≥2 choledochal stones had a high risk of stone recurrence after LCBDE combined with LC ( OR=3.094, 95% CI: 1.069-8.954, P=0.037). In contrast, regular postoperative oral choleretic medication was a protective factor for stone recurrence after LCBDE combined with LC ( OR=0.160, 95% CI: 0.072-0.354, P=0.001). A logistic regression model, based on the number of common bile duct stones and regular postoperative oral choleretic medication, was developed to predict the recurrence of bile duct stones in patients who underwent LCBDE combined with LC. The area under the ROC curve for this model was found to be 0.821 (95% CI: 0.758-0.885). The Hosmer-Lemeshow test, χ 2=7.26, P=0.509, suggested that there is good agreement between the model's predicted probabilities and ideal probabilities. Conclusions:The number of stones (≥2) is an independent risk factor for stone recurrence after LCBDE combined with LC in patients with bile duct stones. Regular postoperative oral choleretic medication is a protective factor for stone recurrence after LCBDE combined with LC. Predictive models based on the number of choledochal stones and regular postoperative oral choleretic medication have better efficacy in predicting postoperative stone recurrence.

Objective:To investigate the precautions and clinical effects of minimally invasive lateral bone transfer of tibia in the treatment of diabetic foot.Methods:A retrospective analysis was performed on 82 patients with diabetic foot admitted to the Trauma Department of Changzhou First People's Hospital from January 2019 to December 2022. According to the Wagner grade of diabetic foot, there were 12 cases of grade 2, 50 cases of grade 3, and 20 cases of grade 4. According to the surgical method, 45 patients were divided into bone transfer group. There were 29 males and 16 females, with an average age of 65.27±10.74 years (ranging from 44-87 years), who underwent minimally invasive bone transfer of tibia combined with local debridement treatment. In the non-bone transfer group, there were 37 cases (26 males and 11 females) with an average age of 66.05±11.08 years (ranging from 44 to 86 years), who were treated with local debridement. Gender, age, Wagner grade, surface temperature difference of the affected limb, visual analogue scale (VAS) score of the affected limb before and 1 month after surgery, wound healing rate 1 month after surgery, and recurrence rate of the affected foot 1 year after surgery were compared between the two groups. Outcomes of the cases of different Wagner grades were compared.Result:All 82 patients were followed up for 14.23±1.20 months. There was no significant difference in gender, age, Wagner grade and preoperative VAS between the two groups ( P>0.05). The skin temperature of the affected limb before and after surgery in the bone transfer group was significantly higher than that in the non-bone transfer group 1.93±0.31 ℃ ( P<0.05), and the VAS of the bone transfer group was 2.18±0.58 points 1 month after surgery, which was lower than that in the non-bone transfer group of 5.41±0.93. The VAS difference before and after surgery in the bone transfer group was 4.80±1.24 points, which was greater than that in the non-bone transfer group of 1.62±1.48 points with significant difference ( P<0.05). The wound healing rate was over 98.78%±2.17% in the bone transfer group and 52.57%±6.41% in the non-bone transfer group one month after surgery. No recurrence or recurrence was found in the bone transfer group one year after surgery, and the recurrence rate was 86% (32/37) in the non-bone transfer group with significant difference ( P<0.05). There was no difference in preoperative VAS for different grades of diabetic foot (grades 2, 3, and 4). There were significant differences in VAS, VAS decrease, postoperative limb surface temperature increase, local wound healing rate at 1 month, and lower limb ulcer recurrence or recurrence rate at 12 months in the bone transfer groups of Wagner grade 2, 3, and 4 ( P<0.05). Conclusion:Minimally invasive lateral bone transfer of tibia combined with local precision debridement could significantly increase the healing rate of diabetic foot ulcer, improve the peripheral microcirculation of the affected limb, reduce the pain of the affected limb, and decrease the recurrence rate of diabetic foot ulcer.

Objective:To investigate the one-stage surgical treatment method and short-term therapeutic effect for combined anterior cruciate ligament (ACL) injury in Schatzker IV-VI tibial plateau fractures.Methods:A retrospective study was conducted on 79 patients with Schatzker IV-VI tibial plateau fractures who underwent surgical treatment at the Department of Traumatic Orthopedics in The Third Affiliated Hospital of Soochow University from April 2016 to February 2021 and there were 47 males and 32 females with a mean age of 51.5±13.2 years (ranging from 21 to 73 years old). Combined with preoperative MRI manifestations, meniscus injuries and avulsion fractures of collateral ligament complex were all repaired in one stage, primary reconstruction was not performed for the combined substantive injury of ACL body, and the displaced avulsion fracture of ACL insertion was only reduced without separate fixation during open reduction and internal fixation for fractures. Visual analogue scale (VAS), knee flexion range of motion, and American Hospital for Special Surgery Knee Joint (HSS) scores were used to evaluate the treatment outcomes at 3, 6, and 12 months postoperatively and the last follow-up.Results:All 79 patients successfully completed the surgery and were followed up for 23.6±2.2 months. The incidence of combined ACL injury was approximately 23% (18/79) with the main manifestation being intercondylar ridge avulsion fracture of ACL (10/18, 56%), which was more common in SchatzkerIV fractures (60%, 6/10). Postoperative KT-1000 measurements on the side-to-side difference in forward displacement of the healthy and affected knee joint showed no significant change in patients with ACL avulsion fracture and body injury, and there was no statistically significant difference compared to the normal range ( P>0.05). No statistically significant difference could be observed in postoperative VAS between ACL avulsion fracture, ACL body injury, and non-ACL injury groups ( P>0.05). At 3, 6, 12 months and the last follow-up after surgery, knee flexion range of motion in patients with intercondylar eminence avulsion fracture of ACL 99.7°±8.9°, 110.5°±10.3°, 120.9°±10.5°, and 121.5°±10.2° was lower than that in patients without ACL injury 106.5°±10.1°, 119.1°±9.8°, 128.3°±10.4°, and 128.3°±9.3°, and the differences were statistically significant ( P<0.05). At 3 and 6 months after surgery, patients with intercondylar eminence avulsion fracture of ACL had lower HSS scores 72.7±5.3 and 80.4±4.6 points compared to those without ACL injury 76.3±4.1 and 83.6±4.5 points, and the differences were statistically significant ( P<0.05). Conclusion:During the surgical treatment of Schatzker IV-VI tibial plateau fractures, it is feasible to treat possible concomitant injuries such as meniscus on the basis of reduction and fixation of the fracture without reconstructing the ACL in one stage, and to treat displaced ACL intercondylar eminence avulsion fractures by correct reduction without separate fixation. This treatment method can achieve good short-term postoperative outcomes.

Objective:To investigate the theoretical knowledge level of clinical nurses engaged in enterostomy nursing in secondary and tertiary general hospitals in Henan Province, so as to provide the basis for departments to carry out specialized training and improve the quality of enterostomy special nursing.Methods:On the basis of literature review and expert letter consultation, enterostomy knowledge test for clinical nurses was formed, including the dimensions of enterostomy special nursing and patient health education. Using the convenient sampling method, clinical nurses who engaged in enterostomy-related nursing work in 39 secondary and tertiary general hospitals in Henan Province were selected as the research objects from February to May 2019. The enterostomy knowledge test for clinical nurses was used to investigate enterostomy specialized knowledge of nurses, and their scores were analyzed by single factor analysis. In this study, a total of 420 tests were issued and 382 valid tests were effectively recovered, with an effective recovery rate of 90.95%.Results:The total score of the enterostomy knowledge test of 382 nurses was (65.80±13.84) , the total score of enterostomy special nursing dimension was (32.17±7.12) , and the total score of patient health education dimension was (33.64±7.66) . 62.83% (240/382) of nurses basically mastered the knowledge of enterostomy. In the enterostomy knowledge test for clinical nurses, the error rates of prevention and identification of complications, management of complications and clinical selection and application of stoma bag were relatively high. There were statistically significant differences in the scores of the enterostomy knowledge test among nurses of different hospital levels, highest educational background, technical title, working time limit and the time limit of engaging in enterostomy nursing work ( P<0.05) . Conclusions:Professional nurses engaged in enterostomy nursing do not have a comprehensive grasp of enterostomy related knowledge, so the departments should pay more attention to special nursing training of enterostomy and improve overall level of enterostomy nursing in the department.

Objective To observe the influence of nutrition cognition and behavior intervention of family caregivers on nutritional status of gastric cancer patients during chemotherapy. Methods We selected 100 patients who received complete chemotherapy at the Department of gastrointestinal surgery from September 2015 to February 2017.Each patient selected 1 family caregiver.It was divided into the control group and the intervention group by the draw method.The control group carried out routine nursing measures.The intervention group carried out nutritional cognitive behavior intervention.The effects of cognitive behavior intervention were investigated by observing the scores of PG-SGA,albumin, prealbumin in gastric cancer patients and the scores of nutrition knowledge,attitude and practice in family caregivers. Results The scores of nutrition knowledge, attitude and practice of the control group and the intervention group were respectively 44.17 ± 9.35 and 46.50 ± 9.32, and the difference was statistically significant(t=15.02, P<0.05).There was significant difference in PG-SGA score, hemoglobin and BMI in patients with gastric cancer patients (P<0.05). There was no significant difference in the incidence of malnutrition and prealbumin in patients with gastric cancer patients (P>0.05). Conclusion Nutrition cognition and behavior intervention can effectively improve the nutritional cognition of family caregivers, improve the nutritional status of gastric cancer patients during chemotherapy, and promote the rehabilitation of patients with gastric cancer and improve their quality of life.

Objective: To explore the effects of continuous care based on WeChat platform on self-care ability of patients with ileal bladder stoma. Methods: A total of 80 patients with ileal conduit were recruited from a urological department of The First Affiliated Hospital of Zhengzhou university from September 2016 to October 2017. The patients were randomly divided into intervention group (n=40) and control group (n=40). Both groups received routine care, and the experimental group also used the continuation care based on WeChat platform. The outcomes of complication incidence, self-care level with stoma were evaluated at the times of 1 day before discharge, 4 weeks after discharge and 12 weeks after discharge. Results: The self-care scores of the intervention group at 3 time points were 5.13 ± 2.79, 9.98 ± 2.68, and 15.65 ± 2.37, The control group were 5.35 ± 3.20, 8.13 ± 3.45, and 12.30 ± 5.93. The interaction of self-care level scores of the two groups were statistically significant (F(1.735, 67.680)=23.301, P<0.05). The incidence of complications of the intervention group at the 3 time points was 5.00%(2/40), 42.50%(17/40), and 22.50% (9/40). The control group were 0(0/40), 51.22% (21/40), and 63.41% (26/40). The incidence of complications in the two groups was statistically significant at the 12th week after discharge (χ²=14.679, P<0.05). Conclusions With continuous care based on WeChat platform, the self-care level of patients with ileal bladder stoma can be effectively improved, and reduce the incidence of complications.

Objective To investigate and analyze the nutritional knowledge needs and cognitive level of the main family caregivers of patients with gastric cancer. Methods A total of 208 patients who underwent radical resection of gastric cancer and received complete chemotherapy at the Department of gastrointestinal surgery from September 2015 to February 2017 were selected.Each patient selected 1 family caregivers.A questionnaire survey was conducted among 208 family caregivers, including general information, nutritional knowledge needs questionnaire, nutrition knowledge, attitude and practice and so on. Results The total score of nutrition knowledge, attitude and practice among the family caregivers of patients with gastric cancer was (41.11 ± 9.33) points. The score of nutrition knowledge was (6.26 ± 1.87) points. The score of nutrition attitude was (15.45±4.75) points.The score of nutrition practice was (17.47± 4.45) points .There was a significant positive correlation between nutrition knowledge and attitude(r=0.88, P<0.05), knowledge and practice (r=0.766, P<0.01), attitude and practice (r=0.186, P<0.01) by using Pearson correlation.Family caregivers had a strong demand for nutrition knowledge. 37.5％(78/208) of family caregivers chose to cooperate with doctors and nurses to carry out nutrition knowledge. 51.4％(107/208) of family caregivers preferred bedside individualized guidance. Conclusions Family caregivers have a strong demand for nutrition knowledge,but the nutrition cognition level is poor. Health care providers should strengthen the education on patients and family caregivers' knowledge of nutrition, improve the nutrition knowledge level of caregivers and care ability.