ObjectiveTo elucidate the critical role of rehabilitation medical records (including electronic records) in rehabilitation medicine's clinical practice and management, comprehensively analyzed the structure, core content and data standards of rehabilitation medical records, to develop a standardized medical record data architecture and core dataset suitable for rehabilitation medicine and to explore the application of rehabilitation data in performance evaluation and payment. MethodsBased on the regulatory documents Basic Specifications for Medical Record Writing and Basic Specifications for Electronic Medical Records (Trial) issued by National Health Commission of China, and referencing the World Health Organization (WHO) Family of International Classifications (WHO-FICs) classifications, International Classification of Diseases (ICD-10/ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), this study constructed the data architecture, core content and data standards for rehabilitation medical records. Furthermore, it explored the application of rehabilitation record summary sheets (home page) data in rehabilitation medical statistics and payment methods, including Diagnosis-related Groups (DRG), Diagnosis-Intervention Packet (DIP) and Case Mix Index. ResultsThis study proposed a systematic standard framework for rehabilitation medical records, covering key components such as patient demographics, rehabilitation diagnosis, functional assessment, rehabilitation treatment prescriptions, progress evaluations and discharge summaries. The research analyzed the systematic application methods and data standards of ICD-10/ICD-11, ICF and ICHI Beta-3 in the fields of medical record terminology, coding and assessment. Constructing a standardized data structure and data standards for rehabilitation medical records can significantly improve the quality of data reporting based on the medical record summary sheet, thereby enhancing the quality control of rehabilitation services, effectively supporting the optimization of rehabilitation medical insurance payment mechanisms, and contributing to the establishment of rehabilitation medical performance evaluation and payment based on DRG and DIP. ConclusionStructured rehabilitation records and data standardization are crucial tools for quality control in rehabilitation. Systematically applying the three reference classifications of the WHO-FICs, and aligning with national medical record and electronic health record specifications, facilitate the development of a standardized rehabilitation record architecture and core dataset. Standardizing rehabilitation care pathways based on the ICF methodology, and developing ICF- and ICD-11-based rehabilitation assessment tools, auxiliary diagnostic and therapeutic systems, and supporting terminology and coding systems, can effectively enhance the quality of rehabilitation records and enable interoperability and sharing of rehabilitation data with other medical data, ultimately improving the quality and safety of rehabilitation services.

Objective:To explore the current status of health information literacy in patients with chronic obstructive pulmonary disease(COPD)and analyze its influencing factors.Methods:A total of 270 patients with COPD were conveniently selected as the research objects from Dec 2021 to Aug 2022 in 3 third-grade grade A hospitals in Zhuzhou City by using convenience sampling.The self-designed general data questionnaire and Health Information Literacy Self-Assessment Questionnaire were used for investigation.Multiple linear regression was used to analyze the factors influencing the health information literacy of COPD patients.Results:The total score of health information literacy of COPD patients was(15.58±2.37),and the average score of each dimension was ranked from high to low as:health information cognition(0.65±0.12),health information morality(0.61±0.11),health information utilization(0.59±0.14),health information evaluation(0.57±0.10),health information acquisition(0.43±0.11).And patients with qualified health information proficiency(≥60 points)accounted for 19.6%.Patients with different ages,personal monthly incomes,occupations,places of residence,education levels,course of disease,self-evaluation of health status,active participation in health management,and knowledge of COPD disease had different health information literacy scores(P＜0.05).Multiple linear regression showed that age,education level,self-evaluation of health status,active participation in health management and knowledge level of COPD disease were influencing factors of health information literacy of COPD patients(P＜0.05),and the above variables together accounted for 27.3%of the total variation degree of health information literacy.Conclusions:The level of health information literacy of COPD patients in a city needs to be further improved,which is influenced by several factors.Medical staff should develop individualized interventions to improve the health information literacy of patients with different characteristics.

Objective:To explore the effect of discharge preparation service based on timing theory on the care readiness and benefit finding of caregivers for elderly dementia patients.Methods:From January 2021 to December 2022, 100 caregivers of elderly dementia patients from the Neurology Department and Rehabilitation Department of Jingjiang People's Hospital were selected as the subject by convenient sampling. Caregivers were divided into a control group and a study group based on their enrollment time, with 50 cases in each group. The control group received routine nursing, while the study group was treated with discharge preparation services based on timing theory. The effect was evaluated using the Caregiver Preparedness Scale (CPS) and Caregiver Benefit Finding Questionnaire.Results:After intervention, the CPS score of the study group was (22.80±2.83), which was higher than the control group's (17.92±2.60), and the difference was statistically significant ( P<0.05). After three months of discharge, the score of the Caregiver Benefit Finding Questionnaire in the study group was (117.50±6.25), which was higher than the control group's (109.98±9.89), and the difference was also statistically significant ( P<0.05) . Conclusions:The discharge preparation service based on timing it right can improve the care readiness and benefit finding of caregivers for elderly dementia patients.

Objective:To determine the risk factors for permanent nerve damage (PND) after aortic arch surgery in patients with acute type A aortic dissection (AAAD).Methods:This was a retrospective case-control study. The medical records from patients of both sexes with AAAD, aged > 18 yr, of American Society of Anesthesiologists Physical Status classification IV, who underwent aortic arch surgery in the Second Hospital of Hebei Medical University from December 2018 to December 2023, were collected. The patients were divided into non-PND group and PND group according to whether PND occurred after operation. The preoperative data of patients were collected, including age, gender, body mass index; comorbidities (hypertension, coronary heart disease, diabetes mellitus), history of smoking, history of stroke, and history of cardiovascular surgeries; syncope at onset, preoperative low SpO 2, preoperative low systolic blood pressure, and preoperative low diastolic blood pressure. The intraoperative data included surgical procedure (total aortic arch replacement or half aortic arch replacement), selective antegrade cerebral perfusion during operation, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, post-parallel time, moderate hypothermia circulatory arrest time, nasopharyngeal temperature and rectal temperature during circulatory arrest, and BIS value during circulatory arrest; blood pressure during cardiopulmonary bypass and after restoration of heart beat; the incidence of dysfunction after recovery of heart beat and difficulty in hemostasis after termination of CPB. The aforementioned indicators were analyzed for difference, and the indicators with P<0.05 were included in the multivariate logistic regression analysis. Results:A total of 292 patients were ultimately included, among which 73 developed postoperative PND, resulting in an incidence of 25.0%. The results of multivariate logistic regression analysis showed that age ≥62 yr ( OR=3.783, 95% confidence interval [ CI] 1.513-10.346, P=0.006), preoperative hypertension ( OR=2.230, 95% CI 1.118-4.715, P=0.028), syncope at onset ( OR=3.001, 95% CI 1.343-6.710, P=0.007), BIS value > 14 during circulatory arrest ( OR=2.439, 95% CI 1.249-4.755, P=0.009) and difficult hemostasis after termination of CPB ( OR=3.465, 95% CI 1.758-6.882, P<0.001) were risk factors for PND after surgery. Conclusions:Age ≥ 62 yr, history of hypertension, syncope at onset, BIS value greater than 14 during circulatory arrest and difficulty in hemostasis after termination of CPB are risk factors for PND after aortic arch surgery in patients with AAAD.

AIM: To explore the improvement effect and mechanism of crocin on cognitive impairmrnt of Alzheimer's disease (AD) rats. METHODS: The hippocampus of SD rats were injected with Aβ 25-35 to establish AD model, then rats were randomly divided into AD group, AD + low, medium, high dose of crocin groups (10, 20, 40 mg/kg) and AD + donepezil group (1 mg/kg), intraperitoneal injection treatment for 4 weeks, set sham group. Dark avoidance test and water maze test were used to evaluate the learning and memory abilities of rats, ELISA was used to detect serum Aβ content, HE staining and Tunel staining were used to determine pathological changes and neuronal apoptosis of hippocampus of rats, immunohistochemistry was used to detect the expression of Brdu, Dcx and NeuN in hippocampus of rats, and Western blot was used to detect the protein expression of Aβ, DKK3, β-catenin, p-GSK-3β/GSK-3β, Caspase-3, Bax, Bcl-2 in hippocampus of rats. RESULTS: Compared to sham group, the learning and memory abilities of AD group rats were decreased, serum Aβ content increased, the pathological change in hippocampus was serious, neuronal apoptosis was increased, the expression of Brdu, Dcx, NeuN were decreased, the protein expression of Aβ, DKK3, p-GSK-3β/GSK-3β, Caspase-3, Bax were increased, protein expression of β-catenin, Bcl-2 were decreased (P<0.01). Compared to AD group, after the treatment of doses of crocin and donepezil, the learning and memory abilities of AD rats were improved, serum Aβ content were increased, and the pathological change in hippocampus were alleviated, neuronal apoptosis were reduced, the expression of Brdu, Dcx, NeuN were decreased, the protein expression of Aβ, DKK3, p-GSK-3β/ GSK-3β, Caspase-3, Bax were decreased, the protein expression of β-catenin, Bcl-2 were increased, notely, dose-dependent effect of crocin was significant. CONCLUSION: Crocin reduced neuronal apoptosis and mediated DKK3 to regulate GSK-3β/ β-catenin pathway to improve the cognitive impairment of AD rats.

Triple negative breast cancer is a subtype of breast cancer with poor prognosis and lack of effective treatment. Cyclin dependent kinase (CDK) 4/6 inhibitors promote antitumor immunity by influencing the triple negative breast cancer immune microenvironment, such as increasing the tumor cell surface pragrammed death-ligand 1 protein expression, enhancing T cell activation and antigen presentation, changing the proportion of T cell subgroup and inducing lymphocyte infiltration. The change of immune microenvironment is related to tumor progression, but its mechanism is extremely complex. Exploring the mechanism of CDK4/6 inhibitor affecting immune microenvironment and its biomarkers can provide a new direction for the diagnosis and treatment of triple negative breast cancer.

Objective:To investigate the status of caregivers' benefit finding of senile dementia patients in Shiyan city, Hubei Province, and to analyze its influencing factors, so as to provide basis for carrying out targeted intervention measures.Methods:Totally 252 caregivers of senile dementia patients who visited Taihe Hospital, Shiyan People′s Hospital and Sinopharm Dongfeng General Hospital in Shiyan City, Hubei Province from July 2019 to July 2021 were selected as the research objects by convenience sampling method. The general Information Questionnaire, the Caregiver benefit finding questionnaire, the General self-efficacy Scale (GSES) and the Perceived Social Support Scale (PSSS) were used. The Pearson correlation analysis method was used for the correlation between caregivers' self-efficacy, social support and perceived benefit. Catreg was used to analyze the influencing factors of caregivers' benefit finding in senile dementia patients.Results:The total score of caregiver benefit questionnaire for 252 caregivers of senile dementia patients was (104.74 ± 14.82), the item "made me realize the significance of my health to my family and society" received the highest score (4.70 ± 0.55), while the item "made me quit bad habits" received the lowest score (3.22 ± 1.17). The GSES and PSSS scores of 252 caregivers of senile dementia patients were (24.74 ± 7.02) and (54.21 ± 13.32), which were positively correlated with the benefit finding ( r=0.565, 0.459, both P<0.01). The catreg analysis showed that the age of the caregiver, the average monthly income of the family, self-efficacy and social support were the influential factors of the perceived benefit level of the caregiver of senile dementia patients ( F values were 3.30-104.92, all P<0.05), which could explain 42.4% of the variance. Conclusions:The benefit finding of caregivers of senile dementia patients still needs to be improved. Medical staff should pay attention to the evaluation of benefit finding of caregivers of senile dementia patients, and provide personalized intervention measures to relieve caregivers' care pressure, maintain their physical and mental health, and improve the care quality of caregivers of senile dementia patients.

Objective: To improve the N biomarker in the amyloid/taueurodegeneration system by radiomics and study its value for predicting cognitive progression in individuals with mild cognitive impairment (MCI). Materials and Methods: A group of 147 healthy controls (HCs) (72 male; mean age ± standard deviation, 73.7 ± 6.3 years), 197 patients with MCI (114 male; 72.2 ± 7.1 years), and 128 patients with Alzheimer’s disease (AD) (74 male; 73.7 ± 8.4 years) were included. Optimal A, T, and N biomarkers for discriminating HC and AD were selected using receiver operating characteristic (ROC) curve analysis. A radiomics model containing comprehensive information of the whole cerebral cortex and deep nuclei was established to create a new N biomarker. Cerebrospinal fluid (CSF) biomarkers were evaluated to determine the optimal A or T biomarkers. All MCI patients were followed up until AD conversion or for at least 60 months. The predictive value of A, T, and the radiomics-based N biomarker for cognitive progression of MCI to AD were analyzed using Kaplan-Meier estimates and the log-rank test. Results: The radiomics-based N biomarker showed an ROC curve area of 0.998 for discriminating between AD and HC. CSF Aβ42 and p-tau proteins were identified as the optimal A and T biomarkers, respectively. For MCI patients on the Alzheimer’s continuum, isolated A+ was an indicator of cognitive stability, while abnormalities of T and N, separately or simultaneously, indicated a high risk of progression. For MCI patients with suspected non-Alzheimer’s disease pathophysiology, isolated T+ indicated cognitive stability, while the appearance of the radiomics-based N+ indicated a high risk of progression to AD. Conclusion We proposed a new radiomics-based improved N biomarker that could help identify patients with MCI who are at a higher risk for cognitive progression. In addition, we clarified the value of a single A/T/N biomarker for predicting the cognitive progression of MCI.

Objective:To explore the curative effect and safety of cold snare polypectomy for colorectal adenoma of less than 15 mm.Methods:Data of 464 colorectal adenoma from 315 patients who were treated with cold snare polypectomy (CSP) and cold endoscopic mucosal resection (cold EMR) in the Third People′s Hospital of Jingdezhen from January 2018 to December 2019 were collected. Patients were divided into group A(3-5 mm), B (6-9 mm), and C (10-15 mm) according to the size of adenoma. Enbloc resection rate, immediate bleeding during polypectomy, delayed postpolypectomy bleeding, cold snare defect protrusions(CSDPs)and postoperative recurrence were analyzed.Results:The overall enbloc resection rate was 99.4%(461/464), and 100.0%(248/248), 98.8%(170/172), 97.7%(43/44) respectively in group A, B, and C without significant difference( P =0.126, 95% CI: 0.097-0.157). The overall incidence of immediate bleeding during polypectomy was 1.1%(5/464), and 0.4%(1/248), 1.7%(3/172), 2.3%(1/44) respectively in group A, B, and C without significant difference( P = 0.267, 95% CI: 0.227-0.308), showing an upward trend in the immediate postpolypectomy bleeding incidence with the increase of diameter of the polyps. No delayed postpolypectomy bleeding occurred. The overall incidence of CSDPs was 20.5%(95/464), 16.4%(63/384) and 40.0%(32/80) in the group of CSP and cold EMR respectively with significant difference( P<0.001, 95% CI: 0-0.006), showing an upward trend in the incidence of CSDPs with the increase of the diameter. A total of 286 adenomas in 195 patients were followed up. The median follow-up time was 9.7 months. Three patients relapsed. Conclusion:CSP is safe and effective for colorectal adenoma ≤15 mm with low incidence of immediate bleeding during polypectomy and recurrence, and no delayed postprocedural bleeding.

Objective:To evaluate the relationship between the application of statins and the risk of hepatocellular carcinoma in patients with chronic liver disease.Methods:PubMed, the Cochrane Library, EMBASE, Web of science, WeiPu, Wanfang Med online, and China National Knowledge Infrastructure database were searched. The literatures about statins and the risk of hepatocellular carcinoma in patients with chronic liver disease were collected, with a search deadline of February 2020. Two researchers independently conducted literature screening, data extraction, quality evaluation and proofreading. RevMan5.3 software was used for data analysis. The I2 combined with χ2 test was used to evaluate the heterogeneity. Funnel plots were used to evaluate the publication bias of the included literature. Results:A total of 12 articles were included. Statins application had significantly reduced the risk of hepatocellular carcinoma in patients with chronic liver disease ( OR = 0.50, 95% CI: 0.43~0.58, P < 0.01). Subgroup analysis showed that statins had reduced the incidence rate of hepatocellular carcinoma in patients with chronic hepatitis B ( OR = 0.56, 95% CI: 0.47~0.66, P < 0.01) and chronic hepatitis C ( OR = 0.56, 95% CI: 0.45~0.71, P < 0.01). Lipophilic statins had significantly reduced the risk of chronic liver disease development to hepatocellular carcinoma ( OR = 0.48, 95% CI: 0.39~0.59, P < 0.01), but hydrophilic statins did not reduce the incidence rate of chronic liver disease development to hepatocellular carcinoma, and the difference was not statistically significant ( OR = 0.64, 95% CI: 0.36~1.14, P = 0.13). Conclusion:Statins can effectively reduce the risk of hepatocellular carcinoma development in patients with chronic liver disease, including chronic hepatitis B and C. Among them, the lipophilic statins have a significant preventive effect on the development of chronic liver disease to hepatocellular carcinoma, but hydrophilic statins have no obvious effect.