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 evaluate the ameliorative effect of Juanbi Tongluo Oral Liquid on sciatic neuronal apoptosis in Type 2 diabetic model mice.METHODS The Type 2 diabetes mouse model was established by feeding with high-fat and high-sugar diet combined with intraperitoneal injection of streptozotocin(STZ).The mice were treated with metformin(200 mg·kg-1·d-1),low dose(3.9 g·kg-1·d-1)and high dose(7.8 g·kg-1·d-1)Juanbi Tongluo Oral Liquid for 35 days.The latency of response to thermal stimu-lation was detected by hot plate,and the values of blood glucose insulin and glycosylated hemoglobin were determined.Biochemical kits were used to detect the expression of serum total cholesterol(T-CHO),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px)and oxidation product malondialdehyde(MDA).The expression of tumor cytokine α(TNF-α),interleukin(IL)-1β,IL-6 and IL-10 in serum of mice were detected by ELISA method;the injury of sciatic nerve of model mice was detected by HE staining;the apoptosis of sciatic nerve was detected by TUNEL method;and the expression of neurofilament protein NF-L,apoptosis(cleaved Caspase-3,Caspase-3)and oxidative stress(Nrf2,HO-1)signal pathway proteins in sciatic nerve of model mice were detected by Western blot method.RESULTS High-dose Juanbi Tongluo Oral Liquid shortened the latent period of heat pain response in model mice(P<0.01);downregulated fasting blood glucose and glycated hemoglobin(P<0.01),and upregulated fasting plasma insulin in model mice(P<0.01);downregulated serum T-CHO,TG,and LDL-C levels(P<0.01),upregulated HDL-C levels(P<0.01);downregulated serum pro-inflammatory factors TNF-α,IL-1β and IL-6 levels(P<0.05),upregulated the anti-inflammatory cyto-kine IL-10 level(P<0.01);inhibited sciatic nerve structural damage and apoptosis(P<0.05);downregulated the ratio of cleaved Caspase-3 to Caspase-3 in the apoptosis pathway(P<0.01);upregulated the expression of neurofilament proteins NF-L and NF-H in sciatic nerve tissue(P<0.05,P<0.01);and upregulated the expression of antioxidant stress proteins Nrf2 and HO-1(P<0.01).CONCLUSION Juanbi Tongluo Oral Liquid can improve sciatic neuronal apoptosis of Type 2 diabetic mice,which may be related to its effect on improving oxidative stress and inflammatory stress.

Objective:To explore the effects of the second dorsal metacarpal artery perforator flap relaying the dorsal island flap of index finger in repairing thumb wounds.Methods:The study was a retrospective observational study. From May 2021 to January 2023, 14 patients with thumb wounds who met the inclusion criteria were admitted to Gansu Provincial People's Hospital, including 8 males and 6 females, aged 24 to 63 years. After debridement, the wound area was 2.1 cm×1.2 cm to 5.5 cm×3.5 cm. The dorsal island flap of index finger with incision area of 2.4 cm×1.5 cm to 5.5 cm×3.5 cm was used to repair the thumb wound, and then the second dorsal metacarpal artery perforator flap with incision area of 2.7 cm×1.6 cm to 5.7 cm×3.6 cm was cut through the same incision to repair the donor wound in the index finger, and the donor wound in the dorsal of hand was directly sutured. The survival of flap was observed, and the healing of the donor wound in the dorsal of hand was observed after operation. The condition of donor wound in the dorsal of hand, the color, appearance, and texture of flap, postoperative complications, return to work, and satisfaction with the treatment effect of patients were followed up. At the last follow-up, the function of the thumb and the index finger was evaluated with the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.Results:After operation, all flaps survived, and the donor wounds on the back of the hands healed. During follow-up of 6-12 months, only linear scars remained on the donor wounds in the dorsal of hands, and the color of flaps was similar to that of the surrounding normal skin, with a full appearance and soft texture. There were no complications such as scar tenderness or scar contracture in any patient. All patients had normal sensation in the thumb and index finger, resumed normal work, and were satisfied with the treatment effects. At the last follow-up, the function of thumb and index finger was evaluated as excellent in 9 cases and good in 5 cases.Conclusions:The second dorsal metacarpal artery perforator flap can repair the thumb wound by relaying the dorsal island flap of index finger, without damaging the major blood vessels, with only linear scars remained on the donor wounds in the dorsal of hands after operation, with good appearance of flap and function of thumb and index finger. The operation is relatively simple with good clinical effects.

Objective To investigate the impact of Coronavirus Disease 2019 (COVID-19) on long-term renal function in patients with chronic kidney disease (CKD) who received no renal replacement therapy. Methods Thirty-nine CKD patients with an estimated glomerular filtration rate (eGFR) < 60 mL/(min·1.73 m²) at the time of COVID-19 diagnosis, admitted to Guizhou Aerospace Hospital from December 2022 to March 2023, were enrolled in the COVID-19 group. Additionally, 40 CKD patients without COVID-19 from September to December 2021, were included in control group. Changes in eGFR were compared between the two groups, and the temporal trend of eGFR in the COVID-19 group was analyzed using a mixed-effects linear model. Results No statistically significant differences were observed in eGFR levels at baseline, 1- and 3-month of follow-up between the COVID-19 and control groups (P>0.05). However, at 1 year of follow-up, the eGFR level in the COVID-19 group was significantly lower than that in the control group (P < 0.05). The mixed-effects linear model analysis revealed a decrease in eGFR by 1.84 mL/(min·1.73 m²) within 1 year of COVID-19 onset in the COVID-19 group, which inclined 4.62% from baseline, with the most significant decline (7.45%) observed among diabetic patients. Conclusion Patients with CKD who have not undergone renal replacement therapy experience a substantial decline in eGFR and worsened renal function within 1 year of COVID-19, necessitating close long-term renal function monitoring and timely interventions.

【Objective】 To explore the effect of recovery autologous blood transfusion combined with bilateral internal iliac artery presetting in high-risk patients with hemorrhage during cesarean section. 【Methods】 A total of 162 high-risk patients with hemorrhage who underwent cesarean section from January 2021 to May 2023 in our hospital were prospectively selected and divided into in Groups A, B, and C with 54 cases in each group according to the indications for the method of transfusion. Group A received allogeneic blood transfusion, Group B received autologous blood transfusion, Group C received autologous blood transfusion combined with bilateral internal iliac artery balloon presetting. 【Results】 Intraoperative blood loss (mL) (1 600 vs 1 500 vs 800), postoperative hospital stay(d) (7 vs 7 vs 6) and operative time(min) (107 vs 104.50 vs 77) in group C were all lower than those in group A and B (P<0.05), with no difference between group A and B (P>0.05); The autologous blood transfusion volume(mL) in group C was lower than that in group B (525.5 vs 261, P<0.05). The proportion of allogeneic erythrocytes in group C was lower than that in group A (22.22% vs 100.00%, P<0.016 7). The proportion of plasma in group C was lower than that in groups A and B (18.50% vs 66.70%/18.50% vs 44.40%, P<0.016 7). The incidence of coagulating dysfunction in group C was lower than that in group A (7.41% vs 25.93%, P<0.016 7). The incidence of hysterectomy in group C was lower than that in group A (1.85% vs 16.67%, P<0.016 7), and there was no difference between group A and B (16.67% vs 11.11%, P>0.016 7). 【Conclusion】 Recovery autologous blood transfusion combined with bilateral internal iliac artery balloon presetting in cesarean section for high-risk patients with hemorrhage achieved ideal effects, which can significantly reduce intraoperative blood loss, intraoperative autologous blood transfusion, allogeneic red blood cells and plasma transfusion, as well as the operation time and postoperative hospital stay. In addition, it can improve the coagulation function and hysterectomy, which is conducive to ensuring the safety of maternal and promoting early rehabilitation, and preserving the fertility of patients to a certain extent, which is worthy of further clinical promotion.

Tumor microenvironment contributes to poor prognosis of pancreatic adenocarcinoma (PAAD) patients. Proper regulation could improve survival. Melatonin is an endogenous hormone that delivers multiple bioactivities. Here we showed that pancreatic melatonin level is associated with patients' survival. In PAAD mice models, melatonin supplementation suppressed tumor growth, while blockade of melatonin pathway exacerbated tumor progression. This anti-tumor effect was independent of cytotoxicity but associated with tumor-associated neutrophils (TANs), and TANs depletion reversed effects of melatonin. Melatonin induced TANs infiltration and activation, therefore induced cell apoptosis of PAAD cells. Cytokine arrays revealed that melatonin had minimal impact on neutrophils but induced secretion of Cxcl2 from tumor cells. Knockdown of Cxcl2 in tumor cells abolished neutrophil migration and activation. Melatonin-induced neutrophils presented an N1-like anti-tumor phenotype, with increased neutrophil extracellular traps (NETs) causing tumor cell apoptosis through cell-to-cell contact. Proteomics analysis revealed that this reactive oxygen species (ROS)-mediated inhibition was fueled by fatty acid oxidation (FAO) in neutrophils, while FAO inhibitor abolished the anti-tumor effect. Analysis of PAAD patient specimens revealed that CXCL2 expression was associated with neutrophil infiltration. CXCL2, or TANs, combined with NET marker, can better predict patients' prognosis. Collectively, we discovered an anti-tumor mechanism of melatonin through recruiting N1-neutrophils and beneficial NET formation.

OBJECTIVE: To explore the genetic mechanism underlying a case with para-Bombay phenotype. METHODS: The ABO and Lewis phenotype were identified with serological methods. The coding regions of exons 6 and 7 of the ABO and FUT1 genes were amplified with PCR and directly sequenced. Haploid sequence analysis was carried out on the variant sites of the FUT1 gene. RESULTS: Serological analysis confirmed that the proband has a rare para-Bombay phenotype. Direct sequencing revealed that he was a B.01/O.01.02 heterozygote for the ABO gene, and had heterozygous deletion for the 768 and 881-882 sites of the FUT1 gene. Further haploid analysis showed that the c.881_882delTT deletion has occurred in one haploid while c.768delC was present in the other haploid. The proband was therefore determined as a FUT1*01N.13/01N.20 heterozygote, which have resulted in frameshift in polypeptide chain p.Phe294Cysfs*40 and p.Val257Phefs*23, respectively. CONCLUSION A rare bi-allelic heterozygous deletion of para-Bombay phenotype has been identified in a blood donor. The c.881_882delTT and c.768delC deletions may decrease the activity of α-1,2-fucosyltransferase.
Animals ; Male ; ABO Blood-Group System/genetics* ; Alleles ; Fucosyltransferases/genetics* ; Genotype ; Heterozygote ; Mutation ; Phenotype ; Humans

Objective:To compare the efficacy of open surgery and arthroscopic assisted surgery in treatment of knee dislocations.Methods:A retrospective case-control study was conducted to analyze the clinical data of 80 patients with knee dislocations admitted to Second Hospital of Lanzhou University from May 2013 to September 2019, including 59 males and 21 females, aged 18-66 years [(42.5±11.6)years]. Open multiple ligament reconstruction was performed in 49 patients (open group) and arthroscopic assisted multiple ligament reconstruction was performed in 31 patients (arthroscopic group). The postoperative hospitalization days, incidence of complications, time needed for recovery of knee range of motion (>0°, >90°, >120°), and time to complete weight-bearing were compared between the two groups. The Lysholm score, international knee documentation committee (IKDC) subjective knee form, Tegner activity level, score of the MOS item short-form health survey (SF-36), patient satisfaction and knee range of motion were compared between the two groups at the last follow-up.Results:All the patients were followed up for 1.2-7.4 years [(3.8±1.5)years]. There was no significant difference in postoperative hospitalization days or incidence of complications between the two groups ( P>0.05). No significant difference was found in time needed for recovery of knee range of motion (>0°, >120°) or time to complete weight-bearing ( P>0.05). The time needed for recovery of knee range of motion (>90°) was 90(60, 90)days in open group and 60(30, 90)days in arthroscopic group ( P<0.05). At the last follow-up, there was no significant difference in Lysholm score, IKDC subjective score, Tegner activity level, SF-36 score, or patient satisfaction between the two groups ( P>0.05). At the last follow-up, the knee range of motion was 120°(90°, 130°) in open group and 135°(120°, 140°) in arthroscopic group ( P<0.05). Conclusion:For treatment of knee dislocations, open surgery and arthroscopic assisted surgery have similar results in the long-term effect, while arthroscopic assisted surgery has benefits in early rehabilitation and ultimately better knee range of motion.

Objective:To investigate the application value of "four doors of the liver" approach in the laparoscopic anatomical hepatectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 52 patients with liver cancer who were admitted to West China Hospital of Sichuan University from September 2018 to September 2019 were collected.Patients underwent laparoscopic anatomical hepatectomy by opening "four doors of the liver" approach. There were 36 males and 16 females, aged (53±16)years, with a range from 35 to 78 years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up and survival. Follow-up using outpatient examination or telephone interview was conducted to detect the physical situations, liver function and recurrence of liver cancer in patients up to March 2020. Measurement data with normal distribution were represented as Mean± SD, and measurment data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations: all the 52 patients underwent laparoscopic anatomical hepatectomy successfully, without perioperative death. Eight and 8 patients underwent laparoscopic left hemihepatectomy and right hemihepatectomy by opening "the first door of the liver" respectively, the operation time of which was (151±31)minutes and (190±43)minutes, the volume of blood loss was (151±20)mL and (361±51)mL. Eight and 8 patients underwent laparoscopic left inner hepatic lobotomy and left outer hepatic lobotomy by opening "the second door of the liver" respectively, the operation time of which was (171±41)minutes and (90±26)minutes, the volume of blood loss was (221±31)mL and (111±21)mL. Eight and 8 patients underwent laparoscopic right posterior hepatic lobotomy and right anterior hepatic lobotomy by opening "the third door of the liver" respectively, the operation time of which was (172±29)minutes and (220±40)minutes, the volume of blood loss was volume of (351±41)mL and (451±47)mL. Four patients underwent laparoscopic hepatic caudate lobotomy by opening "the fourth door of the liver" , the operation time of which was (246±36)minutes, the volume of blood loss was (261±31)mL. None of the 52 patients had blood transfusion. (2) Postoperative situations: all the 52 patients recovered well after surgery, with no complications such as bleeding, biliary fistula, infection or liver failure. The duration of postoperative hospital stay was (7±4)days. (3) Follow-up and survival: all the 52 patients were followed up for 6-17 months, with a median follow-up time of 10 months. At 6 months after operation, all the 52 patients achieved of Eastern Cooperative Oncology Group performance status grade 1, Child-Pugh A of liver function, without tumor recurrence or metastasis. The overall survival rate was 100%(52/52).Conclusion:It is safe and feasible to perform laparoscopic anatomical hepatectomy by the "four doors of the liver" approach.

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) occurs when fetal platelets are sensitized and then phagocytized by macrophages in the reticuloendothelial system after antibodies specific for allogeneic platelets in the pregnant women cross the placenta and enter the fetus. In severe cases, intracranial hemorrhage and even fetal death may occur. This article reviews the recent progress in the following aspects: the mechanisms of pregnancy-related platelet alloimmunity, platelet destruction mechanisms in FNAIT, correlation of anti-angiogenic effects and intracranial hemorrhage, correlation between anti-GPIbα antibodies and miscarriage, and the diagnosis, treatment and prevention of FNAIT.