Objective To explore the efficiency and safety of trans-sheath intraluminal forceps biopsy under digital subtraction angiography(DSA)guidance for assisting diagnosis of pulmonary artery obstructive diseases.Methods Data of 16 patients who underwent trans-sheath intraluminal forceps biopsy for pulmonary artery obstructive diseases were retrospectively analyzed,and the clinical manifestations were recorded.The technical success of biopsy was defined as tissue obtained met the needs of pathology diagnosis.For patients with malignant pathology results,the final diagnosis was malignant,for those with benign pathology results after biopsy and no obvious changes after 6-month or longer follow-up,or benign pathology results after surgical resection,the final diagnosis was benign,otherwise was no clear diagnosis.The operation time,technical success rate,diagnostic efficiency,complications and changes of pulmonary artery pressure before and after the biopsy were observed.Results Among 16 patients,9 complained of intermittent chest tightness,4 complained of chest pain with chest tightness,2 complained of chest pain but 1 denied any symptoms.The lesions located in the left lung in 10 cases and in the right lung in 6 cases,all with enhanced CT showed filling defects of the involved branch of pulmonary artery.Totally 16 trans-sheath intraluminal forceps biopsies were performed in 16 patients,with an average operation time of(31.02±6.02)min and technical success rate of 100%.Malignant tumors were finally diagnosed in 10 cases,including 1 case of lung cancer with false-negative biopsy result,while biopsy correctly diagnosed benign lesions in the other 6 cases.Transient worsening chest pain with chest tightness occurred in 2 cases and relieved after symptomatic treatments.No statistically significant difference of pulmonary artery pressure was found before([53.38±14.28]mmHg)and after([53.69±14.15]mmHg)biopsy(P＞0.05).Conclusion DSA-guided trans-sheath intraluminal forceps biopsy was relatively safe and valuable for assisting diagnosis of pulmonary artery obstructive diseases.

Contemporary college students have low levels of health literacy, facing problems such as weak awareness of health care, unhealthy diet habits, insufficient physical activity, and inadequate emergency response to public health emergencies. The reasons may be related to weak personal awareness of health literacy, imperfect health education system, shortage of health literacy education talents, lack of family health literacy education, and the insufficient social investment in health literacy cultivation. Faced with this current situation, the government, universities, families, individuals, and society should respond to the call of "Healthy China 2030" Plan Outline, regard improving college students’ health literacy level as their own responsibility, help them eliminate or reduce the risk factors affecting health, improve their health literacy level and quality of life, and contribute to the Healthy China strategy.

Adult atlantoaxial complex fractures, an acute injury which is rare in clinic, may lead to neurological damage or even death. Their current treatments can be conservative or surgical. The conservative treatment may involve collar bracket, Halo bracket, and sterno-occipital mandibular immobilizer (SOMI) while the surgical treatment mainly involves anterior cervical fixation and posterior cervical fixation. This review expounds on the current literature concerning the treatment of adult atlantoaxial complex fractures so as to provide reference for correct choice of treatment methods for this kind of fractures.

Objective:To evaluate the fluoroscopy-guided percutaneous transhepatic forceps biopsy (PTFB) in the diagnosis of biliary strictures.Methods:Literatures on diagnosis of biliary strictures by PTFB published from January 2001 to August 2022 were obtained by searching the databases of PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CKNI), Wanfang, VIP, and China Biology Medicine disc (CBM). Literature inclusion and exclusion criteria were established and the retrieved literature was screened. The quality of the included literature was evaluated using the quality assessment of diagnostic accuracy studies (QUADAS-2). Statistical analysis was performed by using Meta-disc software and Stata software.Results:Eighteen articles involving 1 935 patients were finally included. The heterogeneity test suggested no threshold effect, but there was non-threshold heterogeneity in sensitivity and negative likelihood ratio due to other reasons, so a random-effects model was used, and a fixed-effects model were used for the remaining outcome indexes used due to low heterogeneity. The results showed that the pooled sensitivity of fluoroscopy-guided PTFB for the diagnosis of biliary strictures was 0.796 (95% CI: 0.776-0.814), the pooled specificity was 1.000 (95% CI: 0.985-1.000), the pooled positive likelihood ratio was 21.532 (95% CI: 11.281-41.098), the pooled negative likelihood ratio was 0.234(95% CI: 0.169-0.323), the pooled diagnostic odds ratio was 94.321(95% CI: 46.744-190.320), and the area under the summary receiver operating characteristic curve was 0.929. The pooled complication rate was 9.2% (95% CI: 6.4%-12.0%). Conclusion:Fluoroscopy-guided PTFB may be a superior diagnostic tool for biliary strictures.

Objective:To evaluate and summarize the evidence on postoperative exercise in patients with rotator cuff injury, so as to provide a basis for guiding the postoperative exercise in patients with rotator cuff injury.Methods:We searched the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center Database, British Medical Journal (BMJ) Best Practice, UpToData, China Biomedical Literature Database, WanFang Data, China National Knowledge Infrastructure, and other databases on postoperative exercise in patients with rotator cuff injury, including guidelines, evidence summaries, systematic reviews, best practice information books, clinical decision-making, recommended practices, and expert consensus. The retrieval period was from the establishment of the database to June 4, 2022.Results:A total of 30 articles were included, including one guideline, one evidence summary, one clinical decision-making, two expert consensuses, and 25 systematic reviews. 22 pieces of evidence from 12 aspects were summarized, including applicable population, exercise benefit, exercise risk, exercise assessment, exercise program, exercise method, exercise time, exercise intensity, exercise monitoring, formulation principles, management mode, and health education were summarized.Conclusions:The evidence summary process is scientific, rigorous, and comprehensive in content. In the process of evidence transformation, medical and nursing staff should select the best evidence according to specific situations and individual patient factors, so as to guide patients with rotator cuff injury to exercise safely and effectively after surgery to improve clinical outcomes.

Objective:To investigate the hemodynamic changes of the main arteries and veins of the extremities and the heart in patients with hypertrophic scar secondary to extensive burns after pressure treatment, and to analyze the relevant mechanisms.Methods:A retrospective before-after self-control study was conducted. From January 2017 to February 2022, 37 patients with hypertrophic scar secondary to extensive burns who met the inclusion criteria were hospitalized in the Burn Rehabilitation Department of Guangdong Industrial Injury Rehabilitation Hospital, including 25 males and 12 females, aged 23-52 years. The patients were admitted to the hospital within 12 weeks after wound healing, and within one week after admission, rehabilitation therapists, occupational therapists, and tailors custom-made pressure products such as full-body pressure garment, pressure pants, vests, split finger gloves, split finger socks, hoods, and plastic collars, with the pressure at each part maintained at 2.67-4.00 kPa when wearing. Before the first treatment with pressure products (hereinafter referred to as before pressure treatment) and at 1 h of the first treatment with pressure products (hereinafter referred to as 1 h of pressure treatment), color Doppler ultrasonography was performed to check the pulse rate of the axillary artery, the lumen diameter, peak systolic velocity (PSV), and resistance index of the axillary artery and femoral artery on the left side, the lumen diameter, cross-sectional area, and average blood flow velocity of the axillary vein and femoral vein, and the mitral valve E peak, mitral valve A peak, tricuspid valve E peak, aortic valve PSV, and pulmonary valve PSV of the heart; an optical chromatographic skin detector was used to detect the red color, red pigment, and surface brightness of the scar on the back of the hand to reflect the filling and distribution of the scar microvessels. Data were statistically analyzed with paired sample t test. Results:Compared with those before pressure treatment, the PSV of the axillary artery of patients was significantly slowed down at 1 h of pressure treatment ( t=55.42, P<0.01); the average blood flow velocity of the axillary vein was significantly accelerated ( t=-60.50, P<0.01); the pulse rate, lumen diameter, and resistance index of the axillary artery, as well as the lumen diameter and cross-sectional area of the axillary vein did not change obviously ( P>0.05); the average blood flow velocity of the femoral vein was significantly accelerated ( t=-80.52, P<0.01); the lumen diameter, PSV, and resistance index of the femoral artery, as well as the lumen diameter and cross-sectional area of the femoral vein had no significant change ( P>0.05); the mitral valve E peak and mitral valve A peak of the heart decreased significantly (with t values of 10.71 and 21.96, respectively, P<0.01); the tricuspid valve E peak of the heart increased significantly ( t=7.57, P<0.01); the PSV of the aortic valve and pulmonary valve of the heart did not change obviously ( P>0.05). At 1 h of pressure treatment, the red color and red pigment values of the scar on the back of the hand of patients were 15.3±1.1 and 16.8±1.2, respectively, which were significantly lower than 24.5±1.3 and 23.8±1.2 before pressure treatment (with t values of 8.32 and 8.04, respectively, P<0.01). The brightness value of the scar surface on the back of the hand of patients at 1 h of pressure treatment was similar to that before pressure treatment ( P>0.05). Conclusions:After pressure treatment for the hypertrophic scar in patients secondary to extensive burn, the average blood flow velocity of the axillary vein and femoral vein in patients are obviously accelerated, the PSV of the axillary artery is significantly slowed down, the peak values of mitral valve E and mitral valve A of the heart are significantly decreased, and the tricuspid valve E peak is significantly increased. These hemodynamic changes may be related to the reduction of microvascular blood flow in the local area of scar after systemic pressure treatment.

With the transition from quantity-centric healthcare to value-centric healthcare, patient-reported outcome plays an important role in healthcare. Patient-reported outcome is an effective method for evaluating the outcome of hip replacement patients. It can be used not only in science research, but also in clinical practice and medical care quality assessment. This article reviews the patient-reported outcome measures in hip replacement, so as to provide references for clinical practice and research of clinical medical and nursing staff to accurately select appropriate patient-reported outcome measures in hip replacement.

Objective:To systematically analyze and evaluate the bleeding risk prediction model of patients with venous thromboembolism (VTE) , so as to provide a reference for nursing practice.Methods:PubMed, Web of Science, Embase, Cochrane Library, Wiley Online Library, CINAHL, Scopus, ProQuest, Clinicalkey, Wanfang, China National Knowledge Infrastructure, VIP databases were searched for bleeding risk prediction model of VTE patients. The retrieval time was from the establishment of the databases to August 19, 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, then extracted the data and evaluated the quality of the literature.Results:Ten relevant literatures were included in this study, including 4 retrospective studies and 6 prospective studies. The area under the receiver operating characteristic curve of one model was greater than 0.7, and the C-index of four models were greater than 0.7. The prediction model contained many relevant factors, including bleeding history, age, anemia, tumor, antiplatelet therapy, gender, renal insufficiency, etc. In the evaluation of risk of bias and applicability, 10 studies had good applicability, but there were bias mainly due to insufficient number of events in the dependent variable, conversion of continuous variables into dichotomous variables and missing data were not reported. Conclusions:The research on the prediction model of bleeding risk in VTE patients is still in the development stage. In the future, risk prediction models with excellent performance in all aspects and low risk of bias can be developed and verified externally.

Influenza is an acute infectious disease of the respiratory tract and has posed a serious threat to human health. Vaccination is the most effective way to prevent influenza. The traditional inactivated or attenuated live vaccine based on chicken embryo has a long production cycle. Additionally, the surface antigens of vaccine strains and epidemic strains often do not match due to the continuous antigen drift or shift of influenza virus. As a result, the effectiveness of influenza vaccine is significantly reduced, so there is an urgent need to find a rapid and efficient influenza vaccine production strategy to overcome this limitation. In recent years, with the development of genetic engineering technology and various delivery systems, nucleic acid vaccine has been well developed, especially mRNA vaccine has attracted wide attention because of its simple production process and good safety. Therefore, mRNA-based vaccine immunization strategy provides a new direction for the prevention of influenza. This article reviews the molecular design, delivery system and research in influenza in the development of mRNA vaccine, in order to provide a reference basis for the research and development of influenza mRNA vaccine.

Objective:To investigate the clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography (CTA) in repairing skin and soft tissue defects around the knee or in proximal lower leg.Methods:A retrospective cohort study was conducted. From May 2015 to October 2019, 17 patients with skin and soft tissue defects around the knee or in proximal lower leg were admitted to the Department of Orthopedics of Jizhong Energy Xingtai Mig General Hospital, including 12 males and 5 females, aged 16-65 years, with an average age of 35 years. The areas of skin and soft tissue defects after debridement ranged from 6.0 cm×3.0 cm to 15.0 cm×9.0 cm. The retrograde anterolateral thigh perforator flaps were designed according to the origin and distribution of the perforating branches in flaps and the length of the vascular pedicle examined with CTA and the condition of the wound to repair the wounds. The areas of resected flaps ranged from 6.5 cm×3.5 cm to 15.5 cm×9.5 cm. The wounds in donor sites of flaps were sutured directly or covered with medium-thickness skin grafts from healthy upper leg. The sources of the perforating branches in flaps were recorded. The lateral circumflex femoral artery, its branches, and the relative length of the vascular pedicle were compared between preoperative CTA detection and intraoperative observation. The survivals of the flaps were observed. At the last follow-up, the effects of flaps in repairing wounds were evaluated according to evaluation standard of efficacy satisfaction; the motion ranges of flexion and extension of the knee joint were measured, and the knee joint function was evaluated according to the Hohl knee joint function evaluation standard; the sensory function in the flap area was evaluated according to the sensory function evaluation standard formulated by the British Medical Research Council; the wound healing and the occurrence of complication affecting motor function of limb of flap donor sites was observed. Data were statistically analyzed with paired sample t test. Results:The perforating branches in flaps originated from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery in 7, 6, and 4 patients, respectively. The flaps with blood supply from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery were type 1, 2, and 3 retrograde anterolateral thigh perforator flaps, respectively. The preoperative CTA examination of lateral circumflex femoral artery and its branches were consistent with those observed during operation. The relative lengths of vascular pedicles of type 1, 2, and 3 retrograde anterolateral thigh perforator flaps calculated after CTA examination were 0.32±0.13, 0.56±0.07, and 0.56±0.15, which were close to 0.35±0.12, 0.52±0.10, and 0.53±0.12 measured and calculated during operation, respectively ( t=0.45, 0.80, 0.31, P>0.05). All flaps survived in 17 cases without vascular crisis. At the last follow-up, 16 patients were satisfied with effects of flaps in wound repair, with 1 patient feeling average about the effect; the flexion range of knee joint was 100-120°, and the extension range of knee joint was -2-0°; knee joint function was evaluated as excellent in 9 cases, good in 7 cases, and poor in 1 case; the sensory function of the flap area reached S 4 level in 2 cases, S 3 level in 8 cases, and S 2 level in 7 cases; the wounds in flap donor sites healed well; there was no adverse effect in motor function of limbs. Conclusions:Retrograde anterolateral thigh perforator flap is an effective method for repairing skin and soft tissue defects around the knee or in proximal lower leg. Preoperative CTA examination can fully show the anatomical characteristics of the branches of the lateral circumflex femoral artery and the perforating vessels of each branch, which can guide preoperative flap design and operation, thus shortening operation time and improving flap survival rate, with good clinical effects.