Objective:To study the correlation between serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and echocardiographic parameters in patients with chronic Keshan disease, providing reference for diagnosis and prognosis evaluation of chronic Keshan disease.Methods:Ninety-nine patients with chronic Keshan disease who received standardized treatment at Jingchuan County People's Hospital in Pingliang City, Gansu Province from January to December 2020 were selected. Among them, 16 patients were classified as cardiac function grade Ⅱ according to New York Heart Association (NYHA), 69 as grade Ⅲ and 14 as grade Ⅳ. The patients underwent echocardiography and their serum NT-proBNP level was measured using fluorescence immunochromatography. The differences in serum NT-proBNP levels among patients with different cardiac function grades were compared, and the correlation between cardiac function grades, serum NT-proBNP level and echocardiographic parameters was analyzed.Results:The serum NT-proBNP levels in patients with cardiac function grades Ⅱ, Ⅲ, and Ⅳ were (1 107.26 ± 268.03), (2 125.98 ± 293.02), and (8 268.59 ± 2 659.50) pg/ml, respectively. The differences among the three groups were statistically significant ( F = 13.94, P < 0.001). The serum NT-proBNP level was positively correlated with cardiac function grades ( r = 0.44, P < 0.001), left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left atrial diameter ( r = 0.45, 0.52, 0.38, P < 0.001), and negatively correlated with fractional shortening and left ventricular ejection fraction ( r = - 0.39, - 0.46, P < 0.001). Conclusions:The serum NT-proBNP level in patients with chronic Keshan disease with different cardiac function grades is different, and is positively correlated with echocardiographic parameters reflecting the degree of cardiac structural and functional impairment. The NT-proBNP level may become an early diagnostic, grading, and prognostic indicator for chronic Keshan disease.

Objective:To evaluate the application of the standard of "Delimitation and Classification of Keshan Disease Areas" (GB 17020-2010, Standard for short), learn about the applicability of its technical indicators and requirements, and provide a basis for revision of the Standard.Methods:In March 2022, provinces with severe epidemic areas of Keshan disease or new cases reported in recent years were selected, including Gansu Province, Inner Mongolia Autonomous Region, Shandong Province, Shaanxi Province, Yunnan Province, Shanxi Province, Liaoning Province, and Chongqing City. Multi-stage stratified sampling method and questionnaire survey were adopted to collect information on the application of Standard by relevant health institutions.Results:A total of 448 questionnaires were collected, including 445 valid. The survey results showed that 87.64% (390/445) of the respondents were aware of the Standard, and 64.72% (288/445) had received training on the Standard. Eighty-two point two per cent (365/445) of the respondents believed that the Standard was simple and easy to operate, 83.82% (373/445) believed that the determination of the diseased townships was scientific and reasonable, and could be effectively implemented, and 83.60% (372/445) believed that the determination of historical epidemic areas was applicable to the current situation of Keshan disease; 38.88% (173/445), 38.20% (170/445), and 37.98% (169/445) of the respondents believed that the classification indicators for classifying epidemic areas (severe, moderate, and mild epidemic areas) were not applicable to the current situation of the disease in the local or provinces with Keshan disease, respectively. Among the indicators for epidemic areas classification, 30.79% (137/445), 29.21% (130/445), and 28.54% (127/445) of the respondents thought that the annual prevalence, the annual number of new cases and the annual incidence were most suitable for classification of Keshan disease areas.Conclusions:The Standard has been applied well in practice. However, based on the current situation of Keshan disease, it is suggested to redefine the standard for the severity of the disease and the classification of historical epidemic areas.

Objective To compare the effect of extreme learning machine(ELM)vs logistic regression analysis on prediction of the risk to PICC-related central line associated bloodstream infections(PICC-CLABSI)in cancer patients.Methods Clinical data of 1,146 patients who received PICC,from January 2019 to March 2023,in the Department of Oncology of a ⅢA hospital were analysed.A total of 786 patients who received PICC between January 2019 and December 2021 were assigned to the modelling group,and the rest of 360 patients who received PICC between January 2022 and March 2023 were assigned to the validation group.The risk prediction model was established based on the data of modelling group analysed by Chi-square test,and then by the binary logistic regression to determine the statistically significant variables.Based on the analyses of the two models,a nomogram was plotted to evaluate the fitting and predictive effectiveness.Performance of the two models were evaluated using Hosmer-Lemeshow test as well as the area under the curve(AUC)of receiver operating characteristic(ROC).Risk factors identified by the logistic regression and the PICC-CLABSI risks were used as input and output parameters respectively,to establish an ELM prediction model.The two models were compared in terms of predictive effectiveness using the data of the validation group.Results History of diabetes mellitus,frequency of chemotherapy(≥3 times),maintenance cycle(>7 days),maintenance site(out of hospital),white blood cell count(<3.5×109/L),and albumin(<40g/L)were risk factors for PICC-CLABSI in cancer patients.The logistic regression model demonstrated a good predictability by Hosmer-Lemeshow test(χ 2=5.201,P=0.736),with an AUC-ROC of 0.860(95%CI:0.799～0.922),sensitivity at 0.893,specificity at 0.704 and accuracy at 72.8%.The ELM prediction model exhibited a determination coefficient of 0.823 and mean squared error of 0.051,with a fitting rate at 74.5%,hence it indicated a good predictive power.The ELM model showed a superior predictive power than the logistic regression model.Conclusion The ELM model and logistic regression model,based on logistic regression analysis,offers higher prediction accuracy.It provides valuable guidance to healthcare providers in identification of high risks of PICC-CLABSI for cancer patients.

Maculopathy caused by various fundus diseases in the late stage is a common cause of low vision. Medical technology is difficult to reverse the loss of macular function currently, so interventions that help improve the visual system, utilize residual visual function, and improve quality of life deserve attention. Damage to the fovea of the macula does not mean that the entire retinal function is impaired. There may be one or more retinal regions adjacent to the fovea that can serve as a fixation center. It is possible to form stable paracentral fixation, complete functional remodeling of the visual system, and effectively utilize residual visual function by taking appropriate training on these potential paracentral fixation points for most patients. In 2021, a clinical guideline has been published for low vision rehabilitation in China. In order to strengthen the precise management of diseases and develop a standard operating procedure for visual training specifically for patients with low vision due to macular disease, the National Clinical Research Center for Eye Diseases initiated and organized relevant domestic experts, utilizing the latest research experience at home and abroad, and through repeated discussions, this consensus (International Practice Guideline Registration Number: PREPARE-2023CN199) was formed as a reference for ophthalmologists, optometrists and rehabilitation physicians in their clinical research and practice.

Multiple evanescent white dot syndrome (MEWDS) is an acute retinal disease characterized by multifocal white spots in the fundus often seen in the unilateral eye. The lesions mainly involve the retinal pigment epithelium and the outer retinal structure. Typical ocular manifestations of MEWDS include grayish-white outer retinal spots with a clear borderline identified on the fundus, findings of hyper-autofluorescence in the early stage consistent with the spots identified on the fundus, and the optical coherence tomography manifestation of multifocal disruption of the ellipsoid zone. With the rapid development of multimodal imaging technology, some scholars found that these manifestations are not exclusive to MEWDS as some types of chorioretinopathy can also show MEWDS-like changes. The etiology of these diseases may be inflammation, infection, immunity, or tumor-related, misdiagnosed by masquerading as MEWDS. Here we summarized the clinical manifestations and imaging features of MEWDS and reviewed the fundus lesions changes that can be misdiagnosed as MEWDS.

Objective:To compare the application effect among Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale, Medical Outcomes Study 36-item Short Form (SF-36) scale and "Assessment for Therapeutic Efficacy on Kashin-Beck Disease" (WS/T 79-2011) standard in the evaluation of therapeutic effect of patients with Kashin-Beck disease, which could provide basis for the treatment evaluation of patients with Kashin-Beck disease.Methods:A total of 213 patients with Kashin-Beck disease in Gansu Province were investigated. WOMAC scale, SF-36 scale and standard of WS/T 79-2011 were used to analyze the quality of life of patients before and after treatment. The reliability, construct validity, content validity, discriminant validity of WOMAC and SF-36 scales were compared. Correlation between WOMAC, SF-36 scales and standard of WS/T 79-2011 were evaluated.Results:Both WOMAC and SF-36 scales had good construct validity and content validity (construct validity showed WOMAC and SF-36 scales contained 1 and 2 common factors, respectively; content validity showed WOMAC and SF-36 scales contained 3 and 8 common factors, respectively). The reliability and discriminant validity of WOMAC scale were better than those of SF-36 seale (reliability showed WOMAC reliability coefficient ≥0.934, the reliability coefficient of SF-36 scale was ranged from 0.386 to 0.999. Discriminant validity showed there were differences in 3 dimensions of the WOMAC scale before and after treatment, while there were differences in 6 out of 8 dimensions of the SF-36 scale). The correlation coefficients between WOMAC scale and standard of WS/T 79-2011 ranged from 0.175 to 0.437, the correlation coefficients between SF-36 scale and standard of WS/T 79-2011 ranged from - 0.434 to - 0.099 ( P < 0.05). Conclusion:The reliability, discriminant validity and correlation with the standard of WS/T 79-2011 of WOMAC scale are better than those of SF-36 scale in efficacy evaluation of patients with Kashin-Beck disease.

Objective:To evaluate the reliability and validity of the Chinese version of concise health status questionnaire (SF-36 scale) in evaluating the quality of life of patients with chronic Keshan disease, and to provide a scientific basis for studying the quality of life and the evaluation of treatment and rehabilitation of this population.Methods:In the August 2017, using cluster random sampling method, 175 patients with chronic Keshan disease treated by self-management of family beds in Pingliang City, Gansu Province in 2017 were selected as survey subjects, and demographic and disease data were collected. The Chinese version of SF-36 scale was used to investigate the quality of life. Split-half reliability and Cronbach's α coefficient were used to evaluate the reliability of the SF-36 scale; the factor analysis, correlation and differences between groups were used to evaluate the validity of the SF-36 scale.Results:The split-half reliability value of SF-36 scale was 0.916, and the Cronbach's α coefficient was 0.869. Factor analysis extracted 3 common factors from 8 dimensions of SF-36 scale, and the cumulative contribution rate of the 3 common factors to the total variance was 72.08%. In addition to the correlation coefficient ( r) between Role-Emotional and Bodily Pain dimension, the r value between total score and the scores of each dimension, and the scores of each dimension of SF-36 scale were 0.140 - 0.769. Except for the Bodily Pain dimension, there were statistically significant differences in the scores of Physiological Functioning, Role-Physical, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health dimension of the quality of life of patients with different grades of cardiac function ( F = 4.66, 10.73, 6.77, 14.61, 5.58, 9.57, 7.10, P < 0.05). Conclusion:The Chinese version of SF-36 scale has good reliability and validity in evaluating the quality of life of patients with chronic Keshan disease, and can be used to evaluate the quality of life of the patients.

Objective:To master the epidemic trend of Kashin-Beck disease (KBD) in Gansu Province and provide a scientific basis for prevention and treatment of KBD.Methods:All children aged 7 - 12 or 16 years old were selected as the survey subjects in 37 KBD districts and counties in Gansu Province, clinical and X-ray monitoring results of KBD in children from 2004 to 2018 were collected to analyze the epidemic trend of the disease.Results:From 2004 to 2018, a total of 97 190 children were examined clinically and 94 180 X-ray films were taken in Gansu Province. Four hundred and twenty-eight clinical positive cases were detected, with a detection rate of 0.44%. There were 649 X-ray positive cases, and the detection rate was 0.69%. There were 435 metaphyseal positive cases, the detection rate was 0.46%. There were 214 positive cases of bone end, and the detection rate was 0.23%. The clinical positive rate was the highest (7.17%, 58/809) in 2004, followed by 2007 (4.60%, 51/1 109) and 2005 (4.48%, 187/4 173), and the positive rate in other years was less than 3%. The positive rate of X-ray was the highest (9.59%, 58/605) in 2004, followed by 2005 (5.10%, 213/4 173), 2008 (3.66%, 45/1 228) and 2006 (3.04%, 125/4 107), the positive rate of other years was less than 3%.Conclusions:The clinical positive rate and X-ray positive rate of KBD in children in Gansu Province are decreased rapidly and then maintain a low fluctuation. The effect of comprehensive prevention and control measures is remarkable.

Urinary retention is a common complication of bedridden patients in traumatic orthopedics. The severe condition can even cause permanent bladder injury and renal failure, which brings great pain and psychological pressure to patients and seriously hinders their rehabilitation. The traditional Chinese medicine appropriate technologies have the characteristics of safety, effectiveness, low cost, simplicity and easy learning and achieve good clinical effects in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopaedics, including Chinese herbal medicine, acupuncture and moxibustion, massage, etc. The authors summarize the research progress in appropriate technologies of traditional Chinese medicine in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopedics from aspects of action principles, operation methods and effects of acupuncture points, moxibustion therapy, manipulation therapy, external treatment of traditional Chinese medicine and acupoint injection, so as to provide a reference for further nursing research and clinical application.

Objective:To evaluate the reliability and validity of Chinese version of Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale among patients with chronic Keshan disease.Methods:The patients with chronic Keshan disease diagnosed in Keshan disease area of Gansu Province from August 2018 to April 2020 were selected as the survey subjects to analyze the reliability and validity of the Chinese version of MLHFQ scale in evaluating the quality of life of patients with chronic Keshan disease. To evaluate the reliability of MLHFQ scale, the Cronbach's α coefficient was used, and when the Cronbach's α coefficient > 0.8 indicated that the consistency reliability of the scale was good. Kaider-Meyer-Olkin(KMO) statistic and Barlett's sphericity test were used to evaluate whether the scale was suitable for factor analysis (applicable when KMO > 0.6 and Barlett's sphericity test P < 0.05). The principal component analysis and maximum variance method of exploratory factor analysis were used to extract common factors, and the structural validity of the scale was evaluated. The discrimination validity of the scale was evaluated by New York Heart Association (NYHA) cardiac function classification and analysis of variance. Pearson correlation analysis was used to evaluate the content validity of the scale. Results:A total of 333 questionnaires were collected, of which 329 were valid. There were 180 males and 149 females, aged (59.52 ± 9.26) years. The Cronbach's α coefficient of the Chinese version of MLHFQ scale was 0.95 ( > 0.8). Among them, the Cronbach's α coefficients in the physical domain, emotional domain and other domains were 0.93, 0.91 and 0.86, respectively ( > 0.8). The KMO value of the Chinese version of MLHFQ scale was 0.95 ( > 0.6), and Barlett's sphericity test rejected the hypothesis (χ 2 = 5 222.01, P < 0.05). Principal component analysis and maximum variance method were used to extract 3 common factors, which were named kinetic energy of life, physical condition and emotional condition, respectively. The cumulative contribution rate of principal components was 66.22% ( > 50%). Compared with patients with NYHA cardiac function grade Ⅱ and patients with grade Ⅲ and Ⅳ, there were significant differences in the physical domain, other domain and total score ( P < 0.001). The Pearson correlation coefficients between the physical, emotional, and other domains and their respective items ranged from 0.74 to 0.88, 0.78 to 0.90, and 0.56 to 0.80, respectively, and the correlation coefficients between each item and its domain were all > 0.5 ( P < 0.001). Conclusion:The Chinese version of MLHFQ scale has good reliability and validity in patients with chronic Keshan disease in Gansu Province, and can be used to evaluate the quality of life of patients with chronic Keshan disease.