AIM: To analyze and compare the efficacy of binocular visual perception training and suspended vision trainer in postoperative rehabilitation of strabismus.METHODS: A total of 96 children who received surgical treatment from July 2022 to September 2023 were included in the study subjects, and they were group A(n=32), group B(n=32)and group C(n=32). After operation, binocular visual training, visual perception training and suspension vision trainer were used to compare the efficacy among groups.RESULTS: The changes of simultaneous visual function, fusion visual function, stereoscopic visual function, perceptual eye position(horizontal and vertical)and CIXTQ of the three groups of children were observed before training and at 3 mo after training, and the study found that the simultaneous visual function recovered differently at 3 mo after training, with the best recovery in the group B(all P<0.05); there were no significant differences in fusion visual function of the groups A and B(P>0.05), but there were statistical significance in fusion visual function among the three groups(all P<0.05); and there were no significant differences in recovery rate of stereoscopic visual function among the three groups(P>0.05). The improvement of perceptual eye position of the group B, either horizontally or vertically, was better than that of both the group A and group C(all P<0.05).CONCLUSION: Visual perception training has a higher value in the simultaneous visual function, fusion function, stereoscopic visual function, perceptual eye position and quality of life in children with strabismus.

Objective To investigate the effect of the HtrA serine peptidase 3(HTRA3)gene on choroidal neovascu-larization(CNV)and M2 macrophage polarization.Methods Fasting venous blood was collected from 30 patients with wet age-related macular degeneration(wAMD group)and 30 healthy subjects(normal group).The serum HTRA3 messen-ger ribonucleic acid(mRNA)level was detected by quantitative reverse transcription polymerase chain reaction(qRT-PCR).RF/6A cells were randomly divided into the control group,NC-sh group and HTRA3-sh group.Lentiviral vectors of NC-shRNA and HTRA3-shRNA were transfected into RF/6A cells in the NC-sh group and HTRA3-sh group by Lipo-fectamine2000.HTRA3 transfection was detected by qRT-PCR and Western blot.Then,the RF/6A cells were randomly di-vided into the N group,H group,H+NC-sh group and H+HTRA3-sh group.After cell transfection,RF/6A cells in the N group were cultured in a RPMI 1640 complete medium at a normoxia state,and cells in other groups were cultured in a RP-MI 1640 medium with 200 mmol·L-1 CoCl2 at a hypoxia state.Tubule formation was measured by Matrigel.The C57BL/6J mice were divided into the control group,CNV group,CNV+NC-sh group and CNV+HTRA3-sh group,with 12 mice in each group.Mice in the control group were unmodeled mice,and mice in the other groups were laser-induced CNV model mice.NC-shRNA and HTRA3-shRNA lentiviral vectors with a titer of 1 × 1011 TU·mL-1 were administered to mice in the CNV+NC-sh group and CNV+HTRA3-sh group via intravitreal injection.Mice in the control group and CNV group were in-jected with phosphate buffered saline.After 7 days of treatment,the mice were examined by fundus fluorescein angiogra-phy,and the eyeballs received hematoxylin & eosin staining.The mRNA levels of HTRA3,chitinase-like protein 3(Ym-1),arginase 1(Arg-1),inducible nitric oxide synthase(iNOS),cyclooxygenase-2(COX-2)and vascular endothelial growth factor(VEGF)in RF/6A cells or choroidal tissues were detected by qRT-PCR.The protein expression levels of HTRA3,VEGF and nuclear factor kappa B(NF-κB)p65 in RF/6A cells or choroidal tissues were detected by Western blot.Re-sults Compared with the normal group,serum HTRA3 mRNA level of patients in the wAMD group increased(t=11.804,P＜0.001).Compared with the control group and NC-sh group,the expressions of HTRA3 mRNA and protein in RF/6A cells in the HTRA3-sh group decreased(all P＜0.05).Compared with the N group,the number of closed lumen and the mRNA and protein expressions of HTRA3 and VEGF in RF/6A cells in the H group increased(all P＜0.05).Compared with the H+NC-sh group,the number of closed lumen and the mRNA and protein expressions of HTRA3 and VEGF decreased in RF/6A cells in the H+HTRA3-sh group(all P＜0.05).Compared with the control group,the mRNA and protein expression levels of HTRA3 increased,the relative fluorescence intensity of CNV increased,the mRNA levels of Ym-1 and Arg-1 in-creased,the iNOS and COX-2 mRNA levels decreased,and the NF-κB p65 protein expression level increased in mice of the CNV group(all P＜0.05).Compared with the CNV+NC-sh group,the mRNA and protein expression levels of HTRA3 de-creased,the relative fluorescence intensity of CNV decreased,the mRNA levels of Ym-1 and Arg-1 decreased,the mRNA levels of iNOS and COX-2 increased,and the NF-κB p65 protein expression level decreased in mice of the CNV+HTRA3-sh group(all P＜0.05).Conclusion Down-regulation of HTRA3 can inhibit the formation of CNV and the polarization of M2 macrophages.HTRA3 may be an important potential target for the prevention and treatment of wAMD.

Background::Ebstein’s anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein’s anomaly.Methods::A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed.Results::Anatomical correction was performed in 203 (78.7%) operations, 1? ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1? ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period.Conclusion::Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1? ventricle repair and valvular replacement.

Objective:To explore the status quo of diabetes specialist nurses' practice of cultural care and the cultural care dilemma they encountered.Methods:Using descriptive research method, from March to August 2022, 12 diabetes specialist nurses from Class Ⅲ Grade A hospitals in Guangzhou were selected by objective sampling to conduct a one-on-one structured in-depth interview. Colaizzi 7-step analysis method was used to analyze and extract interview data.Results:A total of 3 themes and 10 sub-themes were extracted, including perception of cultural care (lack of understanding of the concept of cultural care), the main contents of cultural care practice (respecting the religious beliefs and customs of diabetes patients, providing language consistency communication for diabetes patients, offering personalized health guidance for diabetes patients, changing diabetes patients' bad health concepts to maintain patients' health, and seeking support systems for diabetes patients), obstacles to practicing cultural care (self-factors, patient factors, environmental factors, organizational management factors) .Conclusions:The diabetes specialist nurses lack the understanding of the concept and content of cultural care, and their cultural care ability is insufficient, but they have implemented some cultural care for diabetes patients in their nursing practice. In view of the cultural care dilemma encountered by this group in clinical work, efforts should be made to solve it through diabetes specialist nurses, relevant experts, hospitals, departments and so on.

Objective:To investigate the current status of the traditional Chinese medicine (TCM) nursing knowledge-attitude-practice of newly recruited nurses in TCM hospitals, so as to provide evidence for improving the standardized training of TCM nursing among newly-recruited nurses.Methods:From March to April in 2020, a total of 800 newly-recruited nurses from 6 TCM hospitals above the municipal level in Hunan Province were selected as research objects by convenient sampling method. The investigation was conducted by TCM Nursing Knowledge-Attitude-Practice Questionnaire. A total of 800 questionnaires were distributed and 768 valid questionnaires were collected, with an effective recovery rate of 96%.Results:The total score of the Knowledge-Attitude-Practice Questionnaire of the newly recruited nurses of the TCM hospital was (191.61±41.80) ; the scores of knowledge and attitude dimension were (73.93±17.21) and (78.17±15.81) , at a middle level; the score of practice dimension was (39.51±8.78) , at a low level. There were significant differences in the total score of the questionnaire among the new nurses with different hospital levels, working years, whether they graduated from a college of TCM and whether they had received the training of TCM nursing knowledge-attitude-practice ( P<0.01) . Conclusions:The newly recruited nurses in TCM hospitals have a high level of TCM nursing knowledge and a positive attitude towards TCM nursing. However, in clinical work, TCM nursing has poor application ability and insufficient use of clinical skills. In-depth study of TCM nursing knowledge should be strengthened, focusing on the cultivation of TCM nursing thinking. It is also important to improve laws, regulations and related rules, and to conduct training according to the different characteristics of new nurses.

Objective To understand the current development situation and the existing problems and deficiencies of the exercise cardiopulmonary rehabilitation development in Level 2 and above the general hospitals in Chongqing, and to analyze and find out the factors restricting the development of cardiopul-monary rehabilitation in Chongqing, and put forward suggestions for reform and development. Methods Through literature research, field visits and questionnaire survey, the condition of 115 Level Two compre-hensive hospital's rehabilitation and exercise cardiopulmonary rehabilitation development in Chongqing was understood. Among them, 500 questionnaires were sent to 6 hospitals concerned with cardiopulmonary rehabilitation service, and 483 questionnaires were received with 351 valid questionnaires. Epidata3.1 and SPSS 13.0 statistical software were used to gather research data. Results The settings rate of 115 secondary general hospital rehabilitation was 41.7％, while only 6 hospitals carried out cardiac rehabilitation and cardio pulmonary rehabilitation. There were few rehabilitation beds, the basic staffing was inadequate and the medical staff ratio was only 2 to 2.6. Besides, there is a severe shortage of full-time health instructors.Conclusion The clinical sports cardiopulmonary rehabilitation in Chongqing is as following: The construc-tion of hospital related policies is lagging behind, the overall development of rehabilitation therapy is unbal-anced, the development is late and the level of operation is low. While the lack of professional health movement means that instructors and medical staff have cognitive impairment, residents have low accep-tance of sports rehabilitation therapy and there are insufficient pathogens, which are the main factors that restrict the development of cardiopulmonary rehabilitation.

Objective To observe the clinical effects of medicine-separated moxibustion in treating renal edema.Methods Totally 134 patients with renal edema in the first affiliated hospital of Hunan University of Chinese Medicine from July 2014 to June 2015 were selected and divided into the observation group and the control group by random number table.Patients in the observation group received conventional nursing and medicine-separated moxibustion treatment,while patients in the control group received conventional treatment and nursing.The clinical effect and patient satisfaction were compared in two groups.Results The total efficiency of hematuria was 96.97％ and negative conversion rate was 54.55％ in the observation group.The total efficiency of hematuria was 80.56％ and negative conversion rate was 36.11％ in the control group.The data in the observation group were significantly better than those of the control group (x2 =4.526,P＜0.05).The total efficiency of proteinuria was 92.68％ and negative conversion rate was 58.54％ in the observation group.The total efficiency of hematuria was 79.07％ and negative conversion rate was 46.51％ in the control group.Data in the observation group were significantly better than those of the control group (x2=5.591,P＜0.05).The weights of patients were lost,urine volume in 24 hours increased and muscle circumference decreased.Besides that,the effect in the observation group was better than that of the control group (P＜0.05).The patient satisfaction of the observation group (100.00％) was significantly better than that in the control group (78.79％) (P＜0.01).Conclusions The medicine-separated moxibustion combined with western medicine can help to improve the clinical efficacy and negative conversion rates of hematuria and proteinuria;reduce the patient's weight,increase urine volume in 24 hours;and significantly reduce leg circumference in treating the patients with renal edema.in addition,it can greatly reduce the relapse of edema,and it is beneficial to improve patient satisfaction,which should be applied to the clinical treatment.

Objective To investigate the effect of the secondary transurethral resection in the treatment of non-muscle invasive bladder cancer(NMIBC).Methods 186 cases with NMIBC were randomly divided into control and experimental groups,both groups were treated by transurethral resection of bladder tumor(TURBT),and experimental group received the secondary TURBT after 4 weeks of the first TURBT.The recurrences of two groups were compared.Results The recurrence rate was significantly lower in experimental group than in the control group(13.8％ vs.37.0％,x2 =13.17,P＜0.05).The recurrence number of the original site was significantly less in experimental group than in the control group(x2 =8.35,P＜0.05).Conclusions The secondary TURBT plays a positive role in NMIBC recurrence.

Objective Using Hitachi 7170 external quality assessment return target value to evaluate the accuracy of 10 items after Regression calibration of the Vistros 350 dry-type Biochemical Analyzer.Methods The same quality control samples were separately tested on two instruments,and results were reported to the clinical National Center for Clinical Laborato-ries.Substituted the external quality assessment return target value result from the National Center for Clinical Laboratories by using Vitros350 into regression calibration equation,then the getting data were compared with the external quality assess-ment return target value obtained from Hitachi 7170,and the deviation analysis was processed.The total error range from the America Clinical Laboratory Amended Bill was used as the standard.For the results within the reference range,error less than 1/2CLIA’88 total error,taken as the comparable judging standard,as it satisfied the requirement.For the results out off the reference range,error less than CLIA’88 total error,those still satisfied the requirement.For those items not meet the requirements,it must to do the regression calibration for Vitros350,using Hitachi 7170 as the standard instrument.Results The deviations of 7 items were all less than 1/2CLIA’88 allowed total error,with LDH was 0.16~-9.89,CK 2.92~6.25, ALT -4.64~-8.07,TBIL 0.08~2.67,TP -0.37~4.41,ALB 2.74~4.77 and URIC 1.04~3.0 respectively,and did not need re-calibration.For GLU and CREA,only one out of the reference range sample,the error range was >1/2CLIA’ 88,but

Objective To evaluate the changes of cerebral perfusion and hemodynamics in the patients with mono-carotid artery stenosis after stenting with the technique of DSA parametric imaging. Methods 15 patients with mono-carotid artery stenosis(the stenosis>75%) undergone carotid stenting were choosed. Digital subtraction imagines of diplo-carotid arteries were acquired before and after operation, then the imagines were processed by special soft ware in personal computer. The region of interest (ROI)were selected in the brain,internal carotid artery and superior sagittal sinus separately, the time-gray scale curves of the ROIs were drawn with the soft ware, from which,then acquired the following parameters from the time-gray scale curves,the largest gray values of brain in disordered side pre-and post-operation, and the parameters including peak value (PV), mean transit time (MTT) ,time to peak (TP), time of appearance to the peak , the max slope rate of the curve and relative time of cerebral circulation were also evalua-ted, respectively. The imaging speed was 7.5 pictures per second. The results were statistically evaluated by using matched-t test. Results Before the stenting, the values of the parameters peak value, the max slope rate of the curve,TP,MTT,relative time of cer-ebral circulation were 108.20±5.58 , 1.23±0.37 , (4.78±0.24)s , (8.20±0.42)s and(4.92±1.03)s , respectively; after the stenting , the values of the parameters above-mentioned were 114.20±7.58, 2.01±0.36, (4.14±0.40)s, (3.55±0.56)sand(4.18±0.89) s , respectively, the difference of the parame-ters above-mentioned pre-and post-operation were statisti-cally significant (t=5.97 , 8.00 , 0.21 , 10.21 , 10.12 and 4.14,P<0.05). Before and after operation, the values of time of appearance to the peak were (5.39±0.24) s and)(5.37±0.78) s , respectively , there was no statistical significance (t=0.21, P> 0.05). Conclusion DSA parametric imaging can be used to evaluate the changes of cerebral perfusion and hemodynamics before and after arterial stenting.