Objective:To explore the experience of self-management dilemma ofadults with emerging ankylosing spondylitis, and to provide reference for the construction of self-management intervention strategies for emerging adults with ankylosing spondylitis.Methods:Descriptive phenomenology was used to conduct in-depth interviews with 14 adults with emerging ankylosing spondylitis in the Rheumatology and Immunology Department of Drum Tower Hospital Affiliated to Medical College of Nanjing University from August 2022 to March 2023. The interview data were analyzed by Colaizzi′s seven-step analysis method.Results:A total of 14 patients completed the interview,10 males, 4 females, aged 21-30 years. In adults with emerging ankylosing spondylitis, there were dilemmas of role maladjustment and disease management disorder, including role maladjustment of disease management and social role maladjustment. Barriers to disease management included weak self-management awareness, insufficient support for self-management information, inadequate self-management skills, and poor compliance with self-management behaviors.Conclusions:The role adaptation and self-management ability of adults with emerging ankylosing spondylitis are seriously inadequate. It is urgent to construct health management strategies for adults with emerging ankylosing spondylitis to help them improve the level of role adaptation and disease management.

BACKGROUND:In clinical work,the stiffness of neck soft tissue in patients with neck and shoulder pain is mainly detected through palpation,which is highly subjective and lacks an objective basis.Real-time shear wave elastography is a quantitative elastic ultrasound technique that can objectively assess muscle elasticity and muscle status. OBJECTIVE:To apply real-time shear wave elastography to assess the stiffness of scalene muscles in patients with neck and shoulder pain and to observe the characteristics of muscle stiffness changes in the bilateral anterior,middle and posterior scalene muscles in patients with neck and shoulder pain. METHODS:From December 2021 to June 2022,36 healthy subjects(control group)and 36 patients with neck and shoulder pain(test group)were recruited at the Shenzhen Hospital of Guangzhou University of Chinese Medicine.Real-time shear wave elastography was applied to measure the mean values of elastic modulus and cross-sectional area of the anterior and middle and posterior scalene muscles bilaterally in the neutral and lateral flexion positions of the neck in both groups. RESULTS AND CONCLUSION:In the same position,there were no significant differences between the mean Values of elastic modulus of the left and right anterior scalene muscles as well as between the mean Values of elastic modulus of the left and right middle scalene muscles in each group(P>0.05);there were no significant differences between the cross-sectional area of the left and right anterior scalene muscles as well as the cross-sectional area of the left and right posteromedial scalene muscles in each group(P>0.05);and the elastic modulus and cross-sectional area of the posteromedial scalene muscles were significantly higher than those of the anterior scalene muscles in both groups(P<0.01,P<0.001).The mean Values of elastic modulus of the anterior and posteromedial scalene muscles were higher in the test group than in the control group in the neutral and lateral neck flexion positions(P<0.001),while the cross-sectional areas of the anterior and posteromedial scalene muscles were lower than those in the control group(P<0.01,P<0.001).To conclude,real-time shear wave elastography can be used to visually evaluate the differences in the mean Values of elastic modulus of the anterior and posteromedial scalene muscles in different states of the neck muscles in patients with neck and shoulder pain,whose bilateral scalene muscles are in a state of strain and stiffness.

Objective To explore the efficacy of modified three-line tension reduction and precise delayed tamponade in nasal septum correction.Methods From January 2021 to January 2023,a total of 94 patients who underwent nasal septum deviation surgery in Department of Otolaryngology,Hangzhou Hospital of Traditional Chinese Medicine,Zhejiang University of Traditional Chinese Medicine were randomly divided into group A and group B,with 47 cases in each group.Patients in group A were treated with traditional nasal septum three-line tension reduction;Patients in group B were treated with modified three-line tension reduction of nasal septum,and iodoform gauze was accurately filled in the deviated part after bilateral nasal tamponade was removed for 2 weeks.The operation time,intraoperative nasal septum mucosal injury and intraoperative blood loss were compared between the two groups.Subjective symptoms were scored by nasal obstruction symptom evaluation(NOSE).Nasal septum deviation was evaluated by nasal endoscopy.Results The number of cases of mucosal injury in group A was more than that in group B;The operation time of group A was longer than that of group B,and the difference was statistically significant(P<0.05).The amount of bleeding in group A was more than that in group B,and the difference was statistically significant(P<0.05).The nasal obstruction symptoms of two groups were improved after operation,and the improvement effect of nasal obstruction symptoms in group B was better,the difference was statistically significant(P<0.05).The deviation of nasal septum in both groups was improved,and the improvement of nasal septum shaping in group B was better than that in group A,the difference was statistically significant(P<0.05).Conclusion The modified three-line tension reduction under nasal endoscopy can achieve the same effect as the traditional three-line tension reduction nasal septum correction.At the same time,it can shorten the operation time,reduce the amount of bleeding,reduce the risk of nasal septum perforation,and accurately delay the micro-filling for about 2 weeks.It can avoid the elastic retraction of nasal septum cartilage and improve the surgical effect.

To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group (DRG) data, explore the key points of intervention and optimization of disease groups in departments, and further promote the rational allocation of department resources.

Objective:To investigate the clinical features and therapeutic efficacy of patients with hereditary leiomyomatosis and renal cell carcinoma(RCC) syndrome-associated RCC (HLRCC-RCC) in China.Methods:The clinical data of 119 HLRCC-RCC patients with fumarate hydratase (FH) germline mutation confirmed by genetic diagnosis from 15 medical centers nationwide from January 2008 to December 2021 were retrospectively analyzed. Among them, 73 were male and 46 were female. The median age was 38(13, 74) years. The median tumor diameter was 6.5 (1.0, 20.5) cm. There were 38 cases (31.9%) in stage Ⅰ-Ⅱand 81 cases (68.1%) in stage Ⅲ-Ⅳ. In this group, only 11 of 119 HLRCC-RCC patients presented with skin smooth muscle tumors, and 44 of 46 female HLRCC-RCC patients had a history of uterine fibroids. The pathological characteristics, treatment methods, prognosis and survival of the patients were summarized.Results:A total of 86 patients underwent surgical treatment, including 70 cases of radical nephrectomy, 5 cases of partial nephrectomy, and 11 cases of reductive nephrectomy. The other 33 patients with newly diagnosed metastasis underwent renal puncture biopsy. The results of genetic testing showed that 94 patients had FH gene point mutation, 18 had FH gene insertion/deletion mutation, 4 had FH gene splicing mutation, 2 had FH gene large fragment deletion and 1 had FH gene copy number mutation. Immunohistochemical staining showed strong 2-succinocysteine (2-SC) positive and FH negative in 113 patients. A total of 102 patients received systematic treatment, including 44 newly diagnosed patients with metastasis and 58 patients with postoperative metastasis. Among them, 33 patients were treated with tyrosine kinase inhibitor (TKI) combined with immune checkpoint inhibitor (ICI), 8 patients were treated with bevacizumab combined with erlotinib, and 61 patients were treated with TKI monotherapy. Survival analysis showed that the median progression-free survival (PFS) of TKI combined with ICI was 18 (5, 38) months, and the median overall survival (OS) was not reached. The median PFS and OS were 12 (5, 14) months and 30 (10, 32) months in the bevacizumab combined with erlotinib treatment group, respectively. The median PFS and OS were 10 (3, 64) months and 44 (10, 74) months in the TKI monotherapy group, respectively. PFS ( P=0.009) and OS ( P=0.006) in TKI combined with ICI group were better than those in bevacizumab combined with erlotinib group. The median PFS ( P=0.003) and median OS ( P=0.028) in TKI combined with ICI group were better than those in TKI monotherapy group. Conclusions:HLRCC-RCC is rare but has a high degree of malignancy, poor prognosis and familial genetic characteristics. Immunohistochemical staining with strong positive 2-SC and negative FH can provide an important basis for clinical diagnosis. Genetic detection of FH gene germ line mutation can confirm the diagnosis. The preliminary study results confirmed that TKI combined with ICI had a good clinical effect, but it needs to be confirmed by the results of a large sample multi-center randomized controlled clinical study.

Objective To explore the role and mechanism of periostin(POSTN)in the proliferation of pulmonary artery smooth muscle cell(PASMC)in hypoxia-induced pulmonary hypertension(HPH).Methods The primary PASMC from male rats were ex-posed to hypoxic environment to simulate HPH.The cells were divided into normoxia group,hypoxia group,hypoxia+control adenovirus transfected group(hypoxia+Ad-shNC group),hypoxia+POSTN silenced adenovirus transfected group(hypoxia+Ad-shPOSTN group),POSTN group,POSTN+U0126 group.α-smooth muscle actin(α-SMA)was used to evaluate the purity of PASMC,CCK-8 assay was performed to detect cell viability,and Western blot was utilized to detect the protein expression level of POSTN,proliferating cell nuclear antigen(PCNA),bone morphogenetic protein type Ⅱ receptor(BMPR2),phosphorylated extracellular signal-regulated ki-nase 1/2(p-ERK1/2),and extracellular signal-regulated kinase 1/2(ERK1/2)in PASMC.Results Compared with the normoxia group,hypoxia promoted the proliferation of PASMC and the expression level of POSTN protein,while inhibited the expression level of BMPR2 protein.Down-regulation of POSTN expression could inhibit hypoxia-induced proliferation of PASMC and restore BMPR2 pro-tein expression level.In addition,POSTN significantly increased the protein expression ratio of p-ERK1/2 or ERK1/2,and the prolifer-ation of PASMC,which could be blocked by U0126.Conclusion In the pathological mechanism of HPH,POSTN promotes the prolifera-tion of PASMC,and its potential mechanism may be related to the regulation of BMPR2 expression and activation of ERK1/2 signaling pathway.

In recent years,growth hormone and insulin-like growth factors have become key regulators of bone metabolism and remodeling,crucial for maintaining healthy bone mass throughout life.Studies have shown that adult growth hormone deficiency leads to alterations in bone remodeling,significantly affecting bone microarchitecture and increasing fracture risk.Although recombinant human growth hormone replacement therapy can mitigate these adverse effects,improving bone density,and reduce fracture risk,its effectiveness in treating osteoporosis,especially in adults with established growth hormone deficiency,seems limited.Bisphosphonates inhibit bone resorption by targeting farnesyl pyrophosphate synthase in osteoclasts,and clinical trials have confirmed their efficacy in improving osteoporosis.Therefore,for adult growth hormone deficiency patients with osteoporosis,the use of bisphosphonates alongside growth hormone replacement therapy is recommended.

Objective:To summarize the relevant evidence of perioperative nutritional management for elderly patients with hip fractures, so as to provide scientific guidance for clinical nursing staff to implement nutritional management.Methods:Literature related to perioperative nutrition management of elderly patients with hip fracture were systematically searched from domestic and foreign guide websites, professional association websites, as well as UpToDate, PubMed, BMJ, Web of Science, Cochrane Library, Embase, CINAHL, Chinese Medical Journal Network, Wanfang Database, CNKI and other databases. The search period was from the establishment of the databases to February 15, 2023. Three researchers conducted quality evaluation and data extraction on the literature.Results:A total of 20 articles were included, including one clinical decision, six guidelines, seven expert consensus and six systematic reviews. After extracting and integrating the evidence included in the literature, a total of 29 best pieces of evidence were finally summarized from eight aspects, such as establishing a multidisciplinary nutrition support team, nutrition risk screening, nutrition assessment and content, nutrition support goals, nutrition support methods, preoperative and postoperative nutrition support, health education and follow-up.Conclusions:This study summarizes 29 best evidence for perioperative nutrition management in elderly patients with hip fractures. Nursing staff can develop scientific and standardized perioperative nutrition management plans for elderly patients with hip fracture based on clinical conditions, improving their nutritional status and clinical prognosis.

Objective To investigate the clinical efficacy of artificial dura mater and epidermal growth factor in the repair of tympanic membrane perforation after endoscopic tympanic membrane repair.Methods 58 patients with tympanic membrane perforation were randomly divided into two groups,29 cases in each.Group A was repaired with gelatin sponge,group B was repaired with artificial dura mater and epidermal growth factor.The tympanic membrane healing was reviewed every month,and the pure tone audiometry was reviewed after 3 months.Results The success rate of repair in group A was 34.48%(10/29),and that in group B was 75.86%(22/29).The difference was statistically significant(P<0.05).The air-bone gap in group A was improved by(7.32±2.68)dB HL,and that in group B was improved by(21.77±4.65)dB HL.The difference was statistically significant(P<0.05).Conclusion Artificial dura mater is a suitable tympanic membrane regeneration scaffold.Epidermal growth factor can promote the healing of tympanic membrane perforation.The combination of the two is a feasible treatment for tympanic membrane repair.

Background: Antibiotic resistance is a significant public health concern around the globe.Antimicrobial peptides exhibit broad-spectrum and efficient antibacterial activity with an added advantage of low drug resistance. The higher water content and 3D network structure of the hydrogels are beneficial for maintaining antimicrobial peptide activity and help to prevent degradation. The antimicrobial peptide released from hydrogels also hasten the local wound healing by promoting epithelial tissue regeneration and granulation tissue formation. Objective: This study aimed at developing sodium alginate based hydrogel loaded with a novel antimicrobial peptide Chol-37(F34-R) and to investigate the characteristics in vitro and in vivo as an alternative antibacterial wound dressing to treat infectious wounds. Methods: Hydrogels were developed and optimized by varying the concentrations of crosslinkers and subjected to various characterization tests like cross-sectional morphology, swelling index, percent water contents, water retention ratio, drug release and antibacterial activity in vitro, and Pseudomonas aeruginosa infected wound mice model in vivo. Results: The results indicated that the hydrogel C proved superior in terms of cross-sectional morphology having uniformly sized interconnected pores, a good swelling index, with the capacity to retain a higher quantity of water. Furthermore, the optimized hydrogel has been found to exert a significant antimicrobial activity against bacteria and was also found to prevent bacterial infiltration into the wound site due to forming an impermeable barrier between the wound bed and external environment. The optimized hydrogel was found to significantly hasten skin regeneration in animal models when compared to other treatments in addition to strong inhibitory effect on the release of pro-inflammatory cytokines (interleukin-1β and tumor necrosis factor-α). Conclusions Our results suggest that sodium alginate -based hydrogels loaded with Chol-37(F34-R) hold the potential to be used as an alternative to conventional antibiotics in treating infectious skin wounds.