Objective In order to explore the influence and effect of case teaching method based on real patients in oto-rhinolaryngology on clinical practice ability of general practice.Methods 96 trainees of general practice in otolaryngology de-partment from January 2018 to January 2021 were randomly divided into two groups:a CBL group and a control group.In the CBL group,CBL teaching method was adopted based on real patients in Otorhinolaryngology.Conventional teaching method was used in the control group.Results The theoretical scores of written test and the examination of clinical skill operation scores of the CBL group and the control group were analyzed.There was significant difference between the two groups(P＜0.05).The students in CBL group were more satisfied with clinical thinking ability,analysis and problem solving ability,active learning abil-ity,learning efficiency,teacher-student interaction,doctor-patient communication ability and consultation skills than the control group.There was significant difference between the two groups(P＜0.05).Conclusion The CBL teaching method can obvi-ously improve the learning enthusiasm and clinical practice ability of general resident training doctors.The teaching quality has been significantly improved.It is of great value to cultivate excellent general practitioners.

Objective To construct an evidence-based prevention and management programme for peristomal moisture-associated skin damage in patients with enterostomy,and to evaluate its clinical effectiveness in improving the knowledge level of nurses and patients about peristomal moisture-associated skin damage in patients with enterostomy and reducing the incidence and severity of peristomal moisture-associated skin damage.Methods Through literature screening,evaluation,and summary,the best evidence for the prevention and management programme of peristomal moisture-associated skin damage in patients with enterostomy was summarized.From October 2021 to March 2022,based on the Ottawa research application model,review indicators were developed based on the best evidence for clinical review,identifying obstacles and promoting factors in evidence application,and developing action strategies to improve the evidence-based practice content for the prevention and management of peristomal moisture-associated skin damage in patients with enterostomy.From April to June 2022,evidence-based practice was conducted in the oncology surgery ward of a tertiary hospital in Anhui Province.The implementation rate of various review indicators by nurses,the knowledge level of peristomal moisture-associated skin damage of nurses and patients,and the incidence and severity of peristomal moisture-associated skin damage were compared before and after evidence-based practice.Results 46 cases were included before the evidence-based practice and 49 cases were included after the evidence-based practice.After evidence-based practice,the implementation rate of each review index was improved;the overall implementation rate increased from(0-66.67％)to(83.33％-100％);the score of the patient's knowledge questionnaire on peristomal moisture-associated skin damage was increased from(69.67±8.31)to(80.18±8.07).The score of the nurse's knowledge questionnaire on peristomal moisture-associated skin damage was increased from(79.83±5.97)to(88.28±5.43).At 4 weeks and 12 weeks of discharge,the incidence of peristomal moisture-associated skin damage was decreased,with a statistically significant difference(P＜0.05);the severity of peristomal moisture-associated skin damage was also significantly reduced,with a statistically significant difference(P＜0.05).Conclusion Conducting evidence-based practice for the prevention and management of peristomal moisture-associated skin damage can effectively improve the implementation rate of nurse review indicators,improve the knowledge level of nurses and patients with peristomal moisture-associated skin damage,and reduce the incidence and severity of peristomal moisture-associated skin damage in patients with enterostomy.

Objective To investigate the feasibility and clinical value of using acicular electrosurgical knife for coniza-tion of cervix in the diagnosis and treatment of cervical intraepithelial neoplasia(CIN).Methods A retrospective analysis was conducted on the surgical data,pathological findings,and pregnancy-related complications of 60 patients who underwent acicular electrosurgical knife conization(AEKC)from January 2016 to December 2019.Results The operation time ranged from 10 to 140 minutes(median,26 minutes),and the amount of bleeding during surgery was minimal to 100 mL(median,10 mL).The cone cutting width is between 1-3 cm,the cone cutting depth is between 0.5-2.5 cm.No hemorrhoeaoccur within 14 days after surgery.The pathological concordance rate before and after surgery was 68.3%,the margins were clear and negative,and the ex-cision rate was 100%.The incidence of cervical incompetency,preterm birth and premature rupture of membranes during preg-nancy after AEKC was 3.3%,18.6%and 23.7%respectively.Conclusion By selecting acicular electrosurgical knife,suffi-cient excision and intraoperative hemostasis were ensured during conization.At the same time,it does not affect the pathological diagnosis of margin.Moreover,it has a low incidence of pregnancy-related complications such as cervical incompetency,preterm birth and premature rupture of membranes.

Transcranial direct current stimulation (tDCS) has become a new method of post-stroke rehabilitation treatment and is gradually accepted by people. However, the neurophysiological mechanism of tDCS in the treatment of stroke still needs further study. In this study, we recruited 30 stroke patients with damage to the left side of the brain and randomly divided them into a real tDCS group (15 cases) and a sham tDCS group (15 cases). The resting EEG signals of the two groups of subjects before and after stimulation were collected, then the difference of power spectral density was analyzed and compared in the band of delta, theta, alpha and beta, and the delta/alpha power ratio (DAR) was calculated. The results showed that after real tDCS, delta band energy decreased significantly in the left temporal lobes, and the difference was statistically significant ( P < 0.05); alpha band energy enhanced significantly in the occipital lobes, and the difference was statistically significant ( P < 0.05); the difference of theta and beta band energy was not statistically significant in the whole brain region ( P > 0.05). Furthermore, the difference of delta, theta, alpha and beta band energy was not statistically significant after sham tDCS ( P > 0.05). On the other hand, the DAR value of stroke patients decreased significantly after real tDCS, and the difference was statistically significant ( P < 0.05), and there was no significant difference in sham tDCS ( P > 0.05). This study reveals to a certain extent the neurophysiological mechanism of tDCS in the treatment of stroke.
Brain/physiopathology* ; Brain Waves/physiology* ; Electroencephalography/methods* ; Humans ; Stroke/therapy* ; Stroke Rehabilitation/methods* ; Transcranial Direct Current Stimulation/methods*

ObjectiveTo analyze the effect of frailty status on the risk of mortality in a community-based population aged 45 years and above in Shanghai with different characteristics， and to provide further basis for population-based interventions for frailty and prevention of adverse outcomes. MethodsData were derived from baseline data from the Shanghai prospective study on AGEing and adult health （2009-2010） and cohort follow-up of causes of death up to October 30， 2021. Frailty index （FI） scores were constructed from 40 variables. Those with frailty index FI≥0.2 were judged to be in a frail state， and a multifactorial Cox regression model was used to calculate the hazard ratio （HR） to evaluate the effect of frailty status on the risk of death in different age groups by gender. Socioeconomic characteristics （age， residence， marital status， education and family economic level， etc.） and health-related behaviors （smoking， alcohol consumption， fruit and vegetable intake， social participation， etc.） were included as control variables. ResultsThe study included 7 978 subjects， 777 （9.7%） of whom were in a frail state. After （11.3±1.8） years of follow-up， 1 043 （13.1%） individuals were dead， including 214 （27.5%） who were frail. The results of the multifactorial Cox regression analysis showed that the effect of frailty on the risk of death in each subgroup was in descending order of men in the middle-aged group （45‒ years） （HR=2.92， 95%CI： 1.38-6.19）， women in the low-aged elderly group （60‒ years） （HR=1.68， 95% CI： 1.08-2.60）， and women in the old-aged elderly group （≥75 years and older） （HR=1.59， 95%CI： 1.22‒2.06）. ConclusionFrailty is associated with the risk of death， and we should focus on the frailty status of men aged 45~59 years and women aged 60 years and above. Early screening and assessment of frailty status and taking appropriate preventive interventions may reduce the occurrence of adverse outcomes and premature death.

As an emerging non-invasive brain stimulation technique, transcranial direct current stimulation (tDCS) has received increasing attention in the field of stroke disease rehabilitation. However, its efficacy needs to be further studied. The tDCS has three stimulation modes: bipolar-stimulation mode, anode-stimulation mode and cathode-stimulation mode. Nineteen stroke patients were included in this research (10 with left-hemisphere lesion and 9 with right). Resting electroencephalogram (EEG) signals were collected from subjects before and after bipolar-stimulation, anodal-stimulation, cathodal-stimulation, and pseudo-stimulation, with pseudo-stimulation serving as the control group. The changes of multi-scale intrinsic fuzzy entropy (MIFE) of EEG signals before and after stimulation were compared. The results revealed that MIFE was significantly greater in the frontal and central regions after bipolar-stimulation ( P< 0.05), in the left central region after anodal-stimulation ( P< 0.05), and in the frontal and right central regions after cathodal-stimulation ( P< 0.05) in patients with left-hemisphere lesions. MIFE was significantly greater in the frontal, central and parieto-occipital joint regions after bipolar-stimulation ( P< 0.05), in the left frontal and right central regions after anodal- stimulation ( P< 0.05), and in the central and right occipital regions after cathodal-stimulation ( P< 0.05) in patients with right-hemisphere lesions. However, the difference before and after pseudo-stimulation was not statistically significant ( P> 0.05). The results of this paper showed that the bipolar stimulation pattern affected the largest range of brain areas, and it might provide a reference for the clinical study of rehabilitation after stroke.
Humans ; Transcranial Direct Current Stimulation/methods* ; Electroencephalography ; Stroke Rehabilitation ; Stroke/therapy* ; Electrodes

Cancer stem cells (CSCs) are a class of cells with self-renewal, differentiation, and tumorigenic potential in tumors. It is currently believed that the resistance of CSCs to chemotherapy and radiotherapy is an important cause of tumor recurrence and metastasis. Researchers have found that related factors in many signaling pathways endow CSCs with the ability to adapt to changes in the microenvironment, including inflammatory factors, hypoxia, low pH, and a lack of nutrients. In recent years, the mechanism of CSCs' resistance to therapy has been studied, mainly including the drug efflux mediated by the ATP-binding cassette transporter, the effect of aldehyde dehydrogenase 1 (ALDH1) activity on tumor stem cells, the enhancement of DNA damage repair and degradation of reactive oxygen species, autophagy, activation of development-related pathways, stimulation of the microenvironment, and EMT. The targeting strategies for CSCs include targeting signaling pathway inhibitors, targeting multidrug resistance, DNA damage repair, ALDH, targeting the tumor microenvironment, immunotherapy, etc. In this review, the research progress in CSCs treatment resistance and related treatment strategies was reviewed.

Transcranial direct current stimulation (tDCS) is an emerging non-invasive brain stimulation technique. However, the rehabilitation effect of tDCS on stroke disease is unclear. In this paper, based on electroencephalogram (EEG) and complex network analysis methods, the effect of tDCS on brain function network of stroke patients during rehabilitation was investigated. The resting state EEG signals of 31 stroke rehabilitation patients were collected and divided into stimulation group (16 cases) and control group (15 cases). The Pearson correlation coefficients were calculated between the channels, brain functional network of two groups were constructed before and after stimulation, and five characteristic parameters were analyzed and compared such as node degree, clustering coefficient, characteristic path length, global efficiency, and small world attribute. The results showed that node degree, clustering coefficient, global efficiency, and small world attributes of brain functional network in the tDCS group were significantly increased, characteristic path length was significantly reduced, and the difference was statistically significant (
Brain ; Electroencephalography ; Humans ; Stroke ; Stroke Rehabilitation ; Transcranial Direct Current Stimulation

Three cases of flagellate shiitake mushroom dermatitis caused by Pleurotus ostreatus, Auricularia auricula, and Flammulina velutipes respectively were reported. Case 1, a 45-year-old male patient, developed multiple flagellate erythematous patches and papules on the trunk, axillae and abdomen without any subjective discomfort 8 hours after ingestion of a large amount of grilled Pleurotus ostreatus. Case 2, a 33-year-old female patient, developed multiple flagellate erythematous patches with mild swelling and itching on the back 1.5 days after consuming a fresh Auricularia auricula salad, and millet-sized papules were densely distributed on the erythematous patches. Case 3, a 54-year-old female patient, developed cord-like, flagellate edematous erythema and papules on the neck, trunk and proximal extremities 72 hours after consuming Flammulina velutipes. Histopathological examination of the dorsal lesions in case 3 showed epidermal spongiosis, intraepidermal blisters, papillary dermal edema, superficial dermal vasodilation, erythrocyte extravasation, inflammatory infiltration composed mainly of lymphocytes around dilated blood vessels, and a few scattered eosinophils. The 3 patients were all diagnosed with flagellate shiitake mushroom dermatitis. Case 1 received no treatment, while cases 2 and 3 were symptomatically treated with topical fluticasone propionate ointment, and achieved recovery of skin lesions after 1 week.

Objective To investigate clinical and reflectance confocal microscopy(RCM)features of extragenital lichen sclerosus et atrophicus.Methods Clinical data and RCM images were collected from 11 patients with extragenital lichen sclerosus et atrophicus in Department of Dermatology of Shenyang No.7 People's Hospital and the First Hospital of China Medical University between October 2010 and October 2016,and retrospectively analyzed.Results Of the 11 patients,9 were female,and 6 had lesions on the neck.RCM imaging showed atrophy of the epidermis,disappearance of high reflectivity and circular structures in the basal layer,blurred dermo-epidermal junction,highly reflective quasi-circular big cells and a few mononuclear cells scattering in the superficial dermis,and homogenization and increased density of collagen.Conclusion Extragenital lichen sclerosus et atrophicus has characteristic RCM presentation.