AIM: To explore retinal microvascular changes in migraine patients using meta-analysis.METHODS: The National Library of Medicine PubMed, Embase, and Cochrane Library were searched to find relevant studies, and the search period was from the creation of database to June 2023. Two investigators independently screened the literatures, extracted data, and evaluated the quality of included studies using the NOS scale. STATA15.0 was used for Meta-analysis and publication bias evaluation, sensitivity analysis was performed for results with large heterogeneity, and the funnel plot and Egger were used to assess the publication bias of the literature.RESULTS:A total of 12 studies, including 217 patients(252 eyes)with migraine with aura(MA), 283 patients(388 eyes)with migraine without aura(MO), and 374 healthy individuals(479 eyes), were included in this Meta-analysis. Several optical coherence tomography angiography(OCTA)indicators, including foveal avascular zone(FAZ)macular or optic disc perfusion density were compared and analyzed. The Meta-analysis results showed that compared with healthy controls, patients with MA had a significant increase in FAZ area and perimeter, a significant decrease in perfusion density of the macular deep capillary plexus(mDCP)except for the fovea, and a significant decrease in perfusion density of the radial peripapillary capillaries(RPC)around the optic disc; the FAZ parameters were significantly increased in MO, while the differences in perfusion density of the macular superficial capillary plexus(mSCP), mDCP and RPC were not statistically significant, except for the perfusion density in the parafovea mDCP.CONCLUSIONS: Both MA and MO patients had an enlarged FAZ area, patients with MA had a significant decrease in mDCP perfusion density, and migraine patients had some degree of retinal ischemia.

AIM:To systematically evaluate the changes in retinal and choroidal thickness in patients with internal carotid artery stenosis by using optical coherence tomography(OCT)through Meta-analysis.METHODS: Literatures on the measurement of retinal and choroidal structure in patients with internal carotid artery stenosis by using OCT from CNKI, VIP, WF, PubMed, the Cochrane Library, SinoMed, and Embase databases were searched for relevant studies. The retrieval time was from the establishment of the databases to January 2024. In addition, quality of the included literatures was assessed by the Newtle-Ottawa scale(NOS), and RevMan 5.4.1 and Stata 16.0 were used for statistical analysis.RESULTS: A total of 17 articles(including 18 studies)were included, and the Meta-analysis results showed that, patients with internal carotid artery stenosis had significantly thinner peripapillary retinal nerve fiber layer(pRNFL), ganglion cell complex(GCC), center macular thickness(CMT), and subfoveal choroidal thickness(SFCT)than the healthy control group(age matched normal population). The pRNFL and SFCT of the ipsilateral eye in patients with internal carotid artery stenosis become thinner compared with the contralateral eye.CONCLUSION:To a certain extent, the morphological structure of the retina and choroid can be altered by stenosis of the internal carotid artery. OCT can non-invasively detect the microstructural changes of the retina and choroid in patients with internal carotid artery stenosis, and can be used for the evaluation of internal carotid artery stenosis.

In the early stage of diabetes retinopathy(DR),the change in the molecular level is often earlier than chan-ges in retinal microvessels.Under the chronic high-glucose environment,oxidative stress,epigenetic changes and other mechanisms cause retinal mitochondrial DNA(mtDNA)damage,affect the transcription process of mtDNA coding genes,and damage the electronic transport chain,leading to a vicious cycle of free radicals,which accelerates the apoptosis of retinal capillary pericytes and endothelial cells,leads to retinal microcirculation dysfunction,and cause DR.This paper will review the epigenetic changes,oxidative stress,damage to replication and repair system,gene mutation and other aspects,in order to elaborate on the research progress of retinal mtDNA damage in the pathogenesis of DR.

The status of lymph node metastasis is an important prognostic factor for many malignant tumors, including lung cancer. In the 8th edition of the TNM staging system for lung cancer, the T staging had obvious changes and refinements, but the N staging had little changes. Recently, several studies have found that the prognosis of patients with the same N stage can vary greatly, suggesting that a more detailed subgroup of patients with the same N stage should be subdivided, including the inclusion of extra-capsular lymph node metastases (ENE). In this review, we reviewed the definition, classification/grading, imaging diagnosis, pathological diagnosis, related molecular markers and their relationship with the prognosis of lung cancer patients.

Objective:To construct a systematic, standardized, scientific and effective evaluation index system for standardized training of newly recruited nurses.Methods:By the literature review, applying the Delphi method and purpose sampling to conduct two rounds of expert consultations to 17 nursing experts from 5 medical units and 1 nursing school from October 2019 to April 2020 to construct the evaluation index system for standardized training of newly recruited nurses.Results:The recovery rates of the two rounds of expert consultation questionnaires were all 100%, and the expert authority coefficient was 0.92. The final evaluation index system for standardized training of newly recruited nurses included 4 first-level indicators (professional literacy, theoretical knowledge, nursing operation skills, and core competency of the post) , 17 second-level indicators, and 52 third-level indicators.Conclusions:The evaluation index system for standardized training of newly recruited nurses established in this study is systematic, scientific and effective, which can provide a reference for standardized training and evaluation of newly recruited nurses, and provide a theoretical basis and practical guidance for improving the training effect and quality.

Objective To investigate the protective effect of dexamethasone on hearing loss induced by canalwall-down mastoidectomy.Methods A total of 76 patients (76 ears) were randomized to dexamethasone group and non dexamethasone group with 38 patients in each group.For dexamethasone group,gelfoam soaked with dexamethasone (5 mg/ml) was topically applied to the round window niche at the end of the surgery,and dexamethasone was administrated intravenously at the dosage of 5 mg/50 kg immediately after the surgery.While for non-dexamethasone group,dexamctbasone was not used.The pure-tone audiograms were performed before mastoidectomy and 90 days after the surgery.Absolute bearing change was defined as the difference in hearing thresholds in decibels before and after the surgery.Results The changes of bone conduction thresholds in dexamethasone group were 8.3± 3.9 dB at 6 kHz,11.3±5.2 dB at 8 kHz,and 10.1±7.2 dB for HPTA (4-6-8 kHz high tone average).As in non-dexamethasone group,the changes of bone conduction thresholds were 13.7±4.6 dB at 6 kHz,25.1±5.4 dB at 8 kHz,19.3±9.7 dB for HPTA.There were significant differences in the changes of bone conduction thresholds between dexamethasone and non dexamethasone groups at frequencies of 6 kHz (P=0.039),8 kHz (P=0.007) and HPTA (P=0.009).Conclusion The results demonstrated that application of dexamethasone significantly reduced sensorineural high frequencies (6 kHz and 8 kHz) hearing loss after canal-wall down mastoidectomy,thus the use of dexamethasone is recommended.

Objective To study the protective effects of salvia miltiorrhiza on acute acoustic trauma (AAT) showed by temporary threshold shifts (TTS) induced by impulse noise.Methods A total of 62 male soldiers from a boot camp were randomly divided into the experimental group and the control group,each with 31 persons.The experimental group was treated with salvia miltiorrhiza,and the control group with placebo.Salvia miltiorrhiza was taken orally at the dosage of 780 mg each time,three times a day for 3 consecutive days before the live fire training and 1 day after the live fire training.The pure tone thresholds of right ears of these two groups were measured and compared 72 hours before live fire training and 6 hours after the live fire training.Results The puretone averages at 0.5,1 and 2 kHz of the right ears of the experimental group and the control group before live fire training were 16.32±6.12 dB and 16.21±5.42 dB,respectively,and the averages at 4,6 and 8 kHz were 14.22±5.16 dB and 14.89±5.38 dB,respectively.There were no significant differences between the 2 groups(P＞0.05).The PTAs of the right ears of the experimental group and the control group 6 hours after live fire training were 21.88±5.71 dB and 21.66±6.62 dB,respectively(P＞0.05),while the HPTAs were 25.89 ± 7.97 dB and 39.75 ± 7.84 dB,respectively(P＜0.01).There were significant differences in TTS between the two groups at 4,6 and 8 kHz(P＜ 0.01).Conclusion Salvia miltiorrhiza can reduce TTS at high frequencies induced by AAT.It has a potential preventive effect on AAT.

Objective To analyze the influencing factors on clinical response to conbercept for diabetic maeular edema (DME).Methods A total of 51 patients (51 eyes) with DME who underwent intravitreal injection of conbercept were included in this retrospective study.The general information (age,sex,body mass index,smoking history,drinking history),blood glucose indicators (duration of diabetes,fasting blood glucose,HbA 1 c),blood pressure indicators (history of hypertension,systolic blood pressure,diastolic blood pressure),lipid indicators [total cholesterol (TC),high-density lipoprotein (HDL),apolipoprotein A (APOA)],biochemical indicators [neutrophil concentration,hemoglobin (HB),serum creatinine (Scr)] were collected.The best corrected visual acuity (BCVA) and macular central macular thickness (CMT) before and after treatment were comparatively analyzed.CMT reduced not less than 20％ and BCVA increased by 2 lines as effective standards.Univariate analysis and multivariate logistic regression analysis were used to determine the factors affecting the efficacy ofintravitreal injection ofconbercept in patients with DME.Results Univariate analysis showed that diastolic blood pressure,HDL,serum neutrophil concentration,baseline CMT and baseline BCVA were associated with edema regression (P＜ 0.05);HbA 1 c was associated with vision improvement (P＜ 0.05).Multivariate logistic regression analysis showed that there was a history of smoking (OR=0.122,95％ CI 0.017-0.887),low diastolic blood pressure (OR=0.850,95％CI 0.748-0.966),low HDL (OR=0.007,95％CI 0.000 1-0.440),thin baseline CMT (OR=0.986,95％CI 0.977-0.995) were independent risk factors for failure outcome of edema regression (P＜0.05);long duration of diabetes (OR=1.191,95％CI 1.011-1.404),high APOA (OR=l.007,95％ CI 1.000-1.013) were independent risk factors for failure outcome of vision improvement.Age,fasting blood glucose,systolic blood pressure,TC,HB,Scr and other indicators had no effect on the efficacy of edema regression and vision improvement after treatment (P＞ 0.05).Conclusions Smoking history,long duration of diabetes,low diastolic blood pressure,low HDL level,high APOA level and thin baseline CMT are independent risk factors for the treatment of DME with intravitreal injection of conbercept.

Objective To explore the application effects of peer assisted learning method on the skill training on clinical nursing for new arrival nurses, so as to provide evidence for clinical skill training. Methods Cluster sampling method was adopted and randomly grouped it as the experimental group (n=185) and the control group (n=186) involved 376 new recruited nurses in the First Affiliated Hospital of Zhengzhou University in 2015. The nurses in experimental group used peer assisted learning method and conventional nursing, and the only conventional nursing was adopted in the control group. The effects in two groups were compared.Results A total of 185 nurses acquired (93.58±4.69) average score in skill examination of experimental group while it was (88.73±4.39) in the control group, and there were statistical significance between two groups (t=10.144,P<0.01). Nurses in experimental group believed they developed greater skills in mastering the theoretical and operation knowledge, as well as the critical thinking ability, communication ability, cooperation ability and so on, and so does the teachers and head nurses in the ward(P<0.05). Conclusions The peer assisted learning method is a good way for nursing skills training and improving the nurse's overall service quality and clinical nursing quality.

Objective To discuss the training mode of intensive care unit (ICU) nurse specialists. Methods The trainees of class of 2014-2015 ICU nurse specialists were chosen as the object of the study, diversified training mode was utilized, namely, an optimized combination of multiple different training modes, theoretical courses+clinical practice+assessments (scenario simulation in small groups and individual practical capability)+review (a survey for the training contents, methods and effectiveness of the courses and instructors/teaching assistants, as well as position competency of the trainees)+case study in nursing+comprehensive review. Results After the training of ICU nurse specialists with diversified training mode, the scores had increased from 54.88 ± 12.45 to 79.63 ± 6.15 in theoretical courses, and from 64.69 ± 11.61 to 92.38 ± 3.10 in clinical operating skills, the differences between the above indexes were statistically significant (t=101.60, 169.96, both P<0.01);the numbers of required 140 skills in clinical practical programs mastered by trainees had increased from 66.53 ± 16.17 to 84.78 ± 21.34, the differences between the above indexes were statistically significant (t=14.866, P<0.01). After the ordered chi-square test the value of position competency before and after the training were statistically significant (χ2=24.62, P < 0.05). The trainees also expressed 100% satisfaction rate of the training courses, instructors/teaching assistants and the training effectiveness. Conclusions The diversified training mode benefits to the improvements of professional knowledge and skills, position competency and team-working, as well as the cultivation and comprehensive quality of ICU nursing specialists.