Grass-roots Hospitals Research Articles

Multivariate Analysis and Prediction Model Construction for Dermatoscope Use by Chinese Dermatologists via an Online Survey.

The use of dermatoscopes is constantly increasing globally, but to date, there are no studies on the use of dermatoscopes by Chinese dermatologists. To determine factors influencing the use of dermatoscopes in China. A web-based questionnaire was designed by the Department of Dermatology at Huashan Hospital affiliated with Fudan University and was published online via the Shanghai Wheat Color Intelligent Technology Company, China. In 2019 and 2022, 1581 and 1507 dermatologists, respectively, were recruited and completed the questionnaire online. In China, the application rate of dermatoscopy is higher in eastern provinces than in western and remote areas. The proportion of doctors from public tertiary hospitals is the highest, with females being the majority. The age range of 30-40 years has the highest proportion, the proportion of doctors with professional titles of attending physician or above is the highest, and the proportion of doctors with a bachelor's degree or above is the highest. By improving the education and professional standards of doctors, providing more training opportunities, simplifying access, and promoting dermatoscopy in grassroots hospitals, we can increase the confidence of dermatologists in the use of dermatoscopy.

Ultrasound-based deep learning radiomics nomogram for differentiating mass mastitis from invasive breast cancer

BackgroundThe purpose of this study is to develop and validate the potential value of the deep learning radiomics nomogram (DLRN) based on ultrasound to differentiate mass mastitis (MM) and invasive breast cancer (IBC).Methods50 cases of MM and 180 cases of IBC with ultrasound Breast Imaging Reporting and Data System 4 category were recruited (training cohort, n = 161, validation cohort, n = 69). Based on PyRadiomics and ResNet50 extractors, radiomics and deep learning features were extracted, respectively. Based on supervised machine learning methods such as logistic regression, random forest, and support vector machine, as well as unsupervised machine learning methods using K-means clustering analysis, the differences in features between MM and IBC were analyzed to develop DLRN. The performance of DLRN had been evaluated by receiver operating characteristic curve, calibration, and clinical practicality.ResultsSupervised machine learning results showed that compared with radiomics models, especially random forest models, deep learning models were better at recognizing MM and IBC. The area under the curve (AUC) of the validation cohort was 0.84, the accuracy was 0.83, the sensitivity was 0.73, and the specificity was 0.83. Compared to radiomics or deep learning models, DLRN even further improved discrimination ability (AUC of 0.90 and 0.90, accuracy of 0.83 and 0.88 for training and validation cohorts), which had better clinical benefits and good calibratability. In addition, the information heterogeneity of deep learning features in MM and IBC was validated again through unsupervised machine learning clustering analysis, indicating that MM had a unique features phenotype.ConclusionThe DLRN developed based on radiomics and deep learning features of ultrasound images has potential clinical value in effectively distinguishing between MM and IBC. DLRN breaks through visual limitations and quantifies more image information related to MM based on computers, further utilizing machine learning to effectively utilize this information for clinical decision-making. As DLRN becomes an autonomous screening system, it will improve the recognition rate of MM in grassroots hospitals and reduce the possibility of incorrect treatment and overtreatment.

Analysis of the Application of the "14th Five-Year Plan" for the Development of Traditional Chinese Medicine in Grassroots Hospitals in the Post-Epidemic Era

The application of TCM treatment methods provided important support for the prevention and treatment of COVID-19 and also brought opportunities for the development of TCM. In the post-pandemic era, the good effects of traditional Chinese medicine have enabled its promotion and application in primary healthcare, laying the foundation for the development of traditional Chinese medicine policies. With the promulgation and application of plans such as the "14th Five Year Plan" for the development of traditional Chinese medicine, this article studies the existing problems and provides corresponding suggestions based on the specific content and application overview of the policy. The problem is that there are discrepancies between the formulation of plans and the actual situation in the region and insufficient specific management efforts in the implementation of plans during the policy implementation process. Based on this, this article proposes the following suggestions. Improvements need to be made from three aspects: establishing an effective management system that is lacking, strengthening education and publicity efforts, and coordinating and planning various development matters.

Community medical service construction: identifying factors that influence medical choice for patients with non-communicable chronic diseases in the Southwest China

BackgroundCommunity medical institutions play a vital role in China’s healthcare system. While the number of these institutions has increased in recent years, their construction contents remain insufficient. The potential of community medical institutions in preventing, screening, diagnosing, and treating non-communicable chronic diseases (NCDs) has not been fully utilized. This study aims to assess the status of construction contents in community medical institutions in Southwest China and examine how these contents influence the medical choices of NCD patients.MethodsDescriptive statistics were used to evaluate the construction content of community medical institutions. Multiple-sets of multinomial logistic regression were employed to analyze the associations and marginal impacts between construction content and medical choices. Shapley value analysis was applied to determine the contribution and ranking of these impacts.ResultsDescriptive statistics revealed satisfactory construction contents in community medical institutions. Notably, factors such as service attitude, nursing services, expert consultations, charging standards, medical equipment, medical examinations, privacy protection, and referrals significantly influenced medical choices. Among these, service attitude, charging standards, and privacy protection had the most significant marginal improvement effects on NCD patients’ choices, with improvements of 12.7%, 10.2%, and 5.9%, respectively. The combined contribution of privacy protection, medical examinations, service attitude, charging standards, and nursing services to medical choices exceeded 80%.ConclusionOptimizing the service contents of community institutions can encourage NCD patients to seek medical care at grassroots hospitals. This study addresses crucial gaps in existing literature and offers practical insights for implementing new medical reform policies, particularly in underdeveloped regions of Southwest China focusing on hierarchical diagnosis and treatment.

Complaint management system and patient satisfaction in grassroots hospitals.

Primary healthcare institutions face limitations in medical resources, leading to concerns from patients and their families regarding the quality of medical services, resulting in complaints against these institutions. This study aims to analyze the causes of complaints and implement improvement measures to enhance the service quality of primary healthcare institutions, increase satisfaction among patients and their families, and reduce the number of complaints. Relevant data were collected, and verified complaints were categorized based on departments, administrative office, and category. Pearson Chi-square test, Spearman correlation analysis, as well as univariate logistic regression were employed to analyze factors influencing patient satisfaction. A complaint-handling process was established, and regulations pertaining to complaints were formulated. Pearson Chi-square test results indicated a significant correlation between satisfaction and departments (P = .016) and administrative office (P = .022). Spearman correlation analysis revealed a significant correlation between satisfaction and departments (ρ = 0.157, P = .017) and administrative office (ρ = 0.151, P = .021). Univariate logistic regression analysis demonstrated a significant correlation between satisfaction and other related complaints in administrative office (OR = 3.321, 95% CI = 1.196-9.218, P = .021). Complaints related to departments and administrative offices are significantly correlated with satisfaction. After the implementation of a complaint management system in primary healthcare institutions, there is a notable improvement in service quality, enhanced patient experience, increased satisfaction, and a reduction in hospital complaints.

Machine-learning-algorithms-based diagnostic model for influenza A in children.

At present, nucleic acid testing is the gold standard for diagnosing influenza A, however, this method is expensive, time-consuming, and unsuitable for promotion and use in grassroots hospitals. This study aimed to establish a diagnostic model that could accurately, quickly, and simply distinguish between influenza A and influenza like diseases. Patients with influenza-like symptoms were recruited between December 2019 and August 2023 at the Children's Hospital Affiliated to Shandong University and basic information, nasopharyngeal swab and blood routine test data were included. Computer algorithms including random forest, GBDT, XGBoost and logistic regression (LR) were used to create the diagnostic model, and their performance was evaluated using the validation data sets. A total of 4188 children with influenza-like symptoms were enrolled, of which 1992 were nucleic acid test positive and 2196 were matched negative. The diagnostic models based on the random forest, GBDT, XGBoost and logistic regression algorithms had AUC values of 0.835,0.872,0.867 and 0.784, respectively. The top 5 important features were lymphocyte (LYM) count, age, serum amyloid A (SAA), white blood cells (WBC) count and platelet-to-lymphocyte ratio (PLR). GBDT model had the best performance, the sensitivity and specificity were 77.23% and 80.29%, respectively. A computer algorithm diagnosis model of influenza A in children based on blood routine test data was established, which could identify children with influenza A more accurately in the early stage, and was easy to popularize.

Rapid Segmentation and Diagnosis of Breast Tumor Ultrasound Images at the Sonographer Level Using Deep Learning.

Breast cancer is one of the most common malignant tumors in women. A noninvasive ultrasound examination can identify mammary-gland-related diseases and is well tolerated by dense breast, making it a preferred method for breast cancer screening and of significant clinical value. However, the diagnosis of breast nodules or masses via ultrasound is performed by a doctor in real time, which is time-consuming and subjective. Junior doctors are prone to missed diagnoses, especially in remote areas or grass-roots hospitals, due to limited medical resources and other factors, which bring great risks to a patient's health. Therefore, there is an urgent need to develop fast and accurate ultrasound image analysis algorithms to assist diagnoses. We propose a breast ultrasound image-based assisted-diagnosis method based on convolutional neural networks, which can effectively improve the diagnostic speed and the early screening rate of breast cancer. Our method consists of two stages: tumor recognition and tumor classification. (1) Attention-based semantic segmentation is used to identify the location and size of the tumor; (2) the identified nodules are cropped to construct a training dataset. Then, a convolutional neural network for the diagnosis of benign and malignant breast nodules is trained on this dataset. We collected 2057 images from 1131 patients as the training and validation dataset, and 100 images of the patients with accurate pathological criteria were used as the test dataset. The experimental results based on this dataset show that the MIoU of tumor location recognition is 0.89 and the average accuracy of benign and malignant diagnoses is 97%. The diagnosis performance of the developed diagnostic system is basically consistent with that of senior doctors and is superior to that of junior doctors. In addition, we can provide the doctor with a preliminary diagnosis so that it can be diagnosed quickly. Our proposed method can effectively improve diagnostic speed and the early screening rate of breast cancer. The system provides a valuable aid for the ultrasonic diagnosis of breast cancer.

Clinical application of posterior tibial artery or peroneal artery perforator flap in curing plate exposure after ankle fracture fixation.

The study aims to evaluate the clinical application of posterior tibial artery or peroneal artery perforator flap in the treatment of plate exposure after ankle fracture fixation. A posterior tibial artery or peroneal artery perforator flap was used on 16 patients with plate exposure after ankle fracture fixation in our hospital between July 2018 and July 2021. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap and the healing observed at the donor site are reported. The sizes of the flaps were 2.5-7.0 cm × 5.0-18.0 cm and averaged 4.0 cm × 12.0 cm. The time required to harvest the posterior tibial artery or peroneal artery perforator flap ranged from 35 to 55 min and averaged 45 min. The amount of intraoperative blood loss ranged from 20 to 50 mL and averaged 35 mL. The duration of postoperative drainage tube placement ranged from 3 to 5 days and averaged 4 days. A total of 15 flaps survived and one flap had partial necrosis and survived after conservative treatment. All donor area defects were directly sewed and stitched without complications. There are multiple advantages of the posterior tibial artery or peroneal artery perforator flap, including simple preparation technique, reliable repair of the defects and without the need for performing microvascular anastomosis. It can be safely used in curing plate exposure after ankle fracture fixation and worth popularizing in grassroots hospitals.

A lightweight super-resolution network with skip-connections.

In some hospitals in remote areas, due to the lack of MRI scanners with high magnetic field intensity, only low-resolution MRI images can be obtained, hindering doctors from making correct diagnoses. In our study, higher-resolution images were obtained through low-resolution MRI images. Moreover, as our algorithm is a lightweight algorithm with a small number of parameters, it can be carried out in remote areas under the condition of the lack of computing resources. Moreover, our algorithm is of great clinical significance in providing references for doctors' diagnoses and treatment in remote areas. We compared different super-resolution algorithms to obtain high-resolution MRI images, including SRGAN, SPSR, and LESRCNN. A global skip connection was applied to the original network of LESRCNN to use global semantic information to get better performance. Experiments reported that our network improved SSMI by 0.8% and also achieved an obvious increase in PSNR, PI, and LPIPS compared to LESRCNN in our dataset. Similar to LESRCNN, our network has a very short running time, a small number of parameters, low time complexity, and low space complexity while ensuring high performance compared to SRGAN and SPSR. Five MRI doctors were invited for a subjective evaluation of our algorithm. All agreed on significant improvements and that our algorithm could be used clinically in remote areas and has great value. The experimental results demonstrated the performance of our algorithm in super-resolution MRI image reconstruction. It allows us to obtain high-resolution images in the absence of high-field intensity MRI scanners, which have great clinical significance. The short running time, a small number of parameters, low time complexity, and low space complexity ensure that our network can be used in grassroots hospitals in remote areas that lack computing resources. We can reconstruct high-resolution MRI images in a short time, thus saving time for patients. Our algorithm can be biased towards practical applications; however, doctors have affirmed the clinical value of our algorithm.

Differences in prevalence and management of chronic kidney disease among T2DM inpatients at the grassroots in Beijing and Taiyuan: a retrospective study

PurposeChronic kidney disease (CKD) has been one of the most common complications in type 2 diabetes mellitus (T2DM) patients. This retrospective study aimed to investigate the regional differences in the prevalence and management of CKD in T2DM inpatients from two grassroots hospitals in Beijing and Taiyuan.MethodsThe sociodemographic status, health history, lifestyle information, biochemical parameters and drug choices of the patients were collected from the Diabetes Care Information System using a retrospective cross-sectional analysis. The presence of CKD was defined as albuminuria (urine albumin-to-creatinine ratio of ≥ 30 mg/g) and/or as a reduced estimated glomerular filtration rate (< 60 ml/min/1.73 m2).Results858 patients with T2DM in Beijing and 1,085 patients with T2DM in Taiyuan were included, with a median age of 61.0 and 61.9 years, respectively. The duration of diabetes was 10.5 and 10.3 years, respectively. The prevalence of CKD in Beijing (39.2%) was significantly higher than in Taiyuan (22.4%). The overall ABC control (A = haemoglobin A1c; B = blood pressure; C = cholesterol) in both the Beijing and Taiyuan groups were not ideal. Patients with CKD tended to use insulin, renin–angiotensin–aldosterone system (RAAS) inhibitors, sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and dyslipidaemia therapy in Taiyuan than in Beijing. The actual proportion of carbohydrate, fat and protein in calories was 49.6%:35.4%:14.4% in Beijing and 61.5%:27.8%:10.8% in Taiyuan.ConclusionsThe higher prescription rates of RAAS inhibitors, SGLT-2i and dyslipidaemia therapy may underlie the fluctuations in the prevalence of CKD in Beijing or Taiyuan. Intensive insulin therapy and personal nutritional guidance, along with the extensive use of RAAS inhibitors, SGLT-2i and dyslipidaemia therapy during follow-up, can all play a positive role in the management of CKD in patients with T2DM in both Beijing and Taiyuan.

Development and validation of a nomogram to predict the recurrence of eyelid sebaceous gland carcinoma.

Eyelid sebaceous gland carcinoma (SGC) is a malignancy with fatal risk, high recurrence rate, and pagetoid spread. Thus, recurrence risk prediction and prompt treatment are extremely important. This study aimed to develop a nomogram to predict SGC recurrence based on potential risk factors. We conducted a retrospective study to train and test a nomogram based on the clinical data of 391 patients across our hospital (304) and other grass-roots hospitals (87). After Cox regression, predictors included in the nomogram were selected, and sensitivity, specificity, concordance index (C-index), etc., were calculated to test their discrimination ability. After a median follow-up period of 4.12 years, SGC recurred in 52 (17.11%) patients. The 1-, 2-, and 5-year recurrence-free survival rates were 88.3%, 85.4%, and 81.6%, respectively. We examined five risk factors, such as lymph node metastasis at initial diagnosis (hazard ratio [HR], 2.260; 95% confidence interval [CI], 1.021-5.007), Ki67 (HR, 1.036; 95% CI, 1.020-1.052), histology differentiation degree (HR, 2.274; 95% CI, 1.063-4.865), conjunctival pagetoid infiltration (HR, 2.100; 95% CI, 1.0058-4.167), and orbital involvement (HR, 4.764; 95% CI, 1.436-15.803). The model had good discrimination in both internal and external test sets. The model had good discrimination in both internal and external test sets. The sensitivity of the internal test and external test set were 0.722 and 0.806, respectively, and specificity of the internal test and external test set were 0.886 and 0.893, respectively. We examined the potential risk factors for eyelid SGC recurrence and constructed a nomogram, which complements the TNM system in terms of prediction, indicating that our nomogram has the potential to reach clinical significance. This nomogram has the potential to assist healthcare practitioners in promptly detecting patients who are at an elevated risk and in tailoring clinical interventions to meet their individualized needs.

Feasibility Analysis of Planned Coronary Rotational Atherectomy Guided by Coronary Angiography for Severe Calcified Coronary Lesions in Grass-Roots Hospitals

Objective: To investigate the feasibility of planned percutaneous coronary Rotational Atherectomy (RA) under the guidance of coronary angiography in the treatment of severe coronary calcification in grass-roots hospitals.

6084 Cases of Adult Tetanus from China: A Literature Analysis.

To describe the clinical characteristics, treatments, and outcomes of tetanus and determine the most appropriate focus for tetanus prevention and treatment to reduce morbidity and mortality in China. Four databases, including the Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, were searched from 1 January, 2000 to 30 October, 2022. In total, 151 articles including 6084 tetanus patients met the inclusion criteria. Additionally, 5925 patients had their gender recorded in detail, among which 66.67% (3950/5925) were male, and 33.33% (1975/ 5925) were female. The average age in the detailed records was reported in 4773 cases, with an overall average age of 46.69. The number of patients' places of residence was 580. Those from rural areas comprised the highest percentage with 88.62% (514 / 580). The causes of injury were recorded in 1592 cases in total; injuries caused by metals, wood, and wooden spikes accounted for the highest percentage with 54.52% (868/1592). Patient outcomes were recorded in 4305 cases, with a mortality of 9.34% (402/4305). The leading causes of death included treatment terminated by family members, asphyxia due to persistent spasms, respiratory failure, and autonomic dysfunction, family automatic abandonment and asphyxia accounted for the highest percentage, both 24.00% (54/225). The overall success rate of tetanus treatment in China has dramatically improved, but the prevention and control of non-neonatal tetanus is still challenging. Focus should be placed on the prevention of adult tetanus and standardizing the use of sedative and spasmolytic drugs. Additionally, medical professionals should popularize tetanus prevention and treatment knowledge among the people and strengthen training in grass-roots hospitals.

Research on the new path of deepening grassroots medical care from the perspective of metaverse

Metaverse and related technologies can break the traditional model in the field of medical care, and provide a feasible infrastructure platform for modern medical care and even future medical care through the Metaverse full-scene interaction mode, and improve medical services with computing power The ability to combine clinical research with clinical practice provides the possibility to break down the time and space barriers of medical care. The current level of grassroots medical care lags behind that of the city. It is of great practical significance to study the feasibility of implementing virtual surgical micro-manipulation technology in grassroots medical care under the perspective of metaverse and the current awareness of grassroots people on virtual medical technology to solve this problem. [Research method] Based on the provincial college students' innovation and entrepreneurship project "Virtual Surgical Micromanipulation Technology under the Perspective of Yuan Universe", this research group relies on the social practice team of Anhui Medical University's 2022 summer trips to the countryside to go to a town in Shou County, Huainan City, Anhui Province. Investigate science popularization activities to understand the current level of understanding of the grassroots people on the new medical model and investigate the feasibility and generalization of virtual surgery micro-manipulation technology under the perspective of the metaverse in grassroots hospitals. [Research conclusion] In view of this, the analysis of the questionnaire survey results of grassroots general practitioners and grassroots people shows that the current level of grassroots medical care has a lot of room for development, the level of general practitioners needs to be improved, the concept of the metaverse needs to be popularized and promoted, and the masses are not interested in new medical technologies. The ability to accept is high, and Metaverse virtual medical care can be promoted and feasible at the grassroots level.

Discussion on the Effect and Clinical Availability of Rational Drug Treatment for Hypertensive Patients in Primary Hospitals

From August 2021 to August 2022, our hospital randomly selected 90 hypertensive patients and divided them into two groups. They were treated with two different medication methods, and the clinical effects and complications after treatment were analyzed and compared between groups; Analyze the changes in blood pressure before and after treatment and compare between groups. The results indicate that the selection of reasonable medication for hypertensive patients in grassroots hospitals has a good effect, can stabilize their blood pressure within the normal range, and the combination of medication will not increase adverse reactions. The safety is worthy of recognition. This article will explore the effectiveness and clinical availability of rational drug treatment for hypertensive patients in grassroots hospitals.

Modified plasmakinetic enucleation and resection of the prostate by three glands: proposal of a novel anatomical treatment for benign prostatic hyperplasia

Transurethral resection of the prostate (TURP) cannot completely resect hyperplastic tissues and is often associated with high recurrence rate and short recurrence interval. Western and Chinese scholars have reported higher incidences of stress urinary incontinence (SUI) with traditional enucleations. This study investigated the potential applicability of Modified Plasmakinetic Enucleation and Resection of the Prostate by three glands (MPKERP) in treating benign prostatic hyperplasia (BPH). Between April 2020 and June 2021, 28 patients underwent MPKERP for BPH. The surgical procedures included (1) surgical capsule exploration; (2) moderate range enucleation; (3) middle gland enucleation; (4) sector resection at 12 o’clock in the lithotomy position; (5) cut residual distal urethral mucosa; (6) lateral hyperplastic glands enucleation. All 28 patients recovered well after the surgery, and the curative effect was satisfactory. The average operation time was 68.9 ± 21.8 min, the average weight of excised glands was 62.5 ± 19.1 g, the average indwelling catheter time was 4.6 ± 0.6 d, and the average bladder washing time was 28.6 ± 9.5 h. The average postoperative 1-day hemoglobin decrease was 10.2 ± 9.8 g/L. Only one severe hyperplasia patient had transient SUI (incidence rate: 3.6%). No complications, such as urethral stricture, dysuria, urinary incontinence and urinary retention, were reported during follow-up. International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax) and post-void residual volume (PVR) significantly improved three months after surgery (p &lt; 0.0001). The MPKERP can enucleate and resect the hyperplastic glands anatomically in an orderly manner and pay attention to expanding space, reducing resistance, reducing the damage of pushing and pulling, protecting the urethral sphincter complex (USC), and reducing the incidence of urinary incontinence. Altogether, our findings support MPKERP as an improved surgical technique worthy of promotion, and it is more suitable for grass-roots hospitals that lack hardware equipment.

Risk of primary osteoporosis score (RPOPs): an algorithm model for primary osteoporosis risk assessment in grass-roots hospital

BackgroundThis study aimed to develop and validate a lasso regression algorithm model which was established by correlation factors of bone mineral density (BMD) and could be accurately predicted a high-risk population of primary osteoporosis (POP). It provides a rapid, economical and acceptable early screening method for osteoporosis in grass-roots hospitals.MethodsWe collected 120 subjects from primary osteoporosis screening population in Zhejiang Quhua Hospital between May 2021 and November 2021 who were divided into three groups (normal, osteopenia and osteoporosis) according to the BMD T-score. The levels of three micro-RNAs in the plasma of these people were detected and assessed by qRT-PCR. At the same time, the levels of β-CTX and t-P1NP in serum of the three groups were determined. Based on the cluster random sampling method, 84 subjects (84/120, 70%) were selected as the training set and the rest were the test set. Lasso regression was used to screen characteristic variables and establish an algorithm model to evaluate the population at high risk of POP which was evaluated and tested in an independent test cohort. The feature variable screening process was used 10-fold cross validation to find the optimal lambda.ResultsThe osteoporosis risk score was established in the training set: Risk of primary osteoporosis score (RPOPs) = -0.1497785 + 2.52Age − 0.19miR21 + 0.35miR182 + 0.17β-CTx. The sensitivity, precision and accuracy of RPOPs in an independent test cohort were 79.17%, 82.61% and 75%, respectively. The AUC in the test set was 0.80. Some risk factors have a significant impact on the abnormal bone mass of the subjects. These risk factors were female (p = 0.00013), older than 55 (p < 2.2e-16) and BMI < 24 (p = 0.0091) who should pay more attention to their bone health.ConclusionIn this study, we successfully constructed and validated an early screening model of osteoporosis that is able to recognize people at high risk for developing osteoporosis and remind them to take preventive measures. But it is necessary to conduct further external and prospective validation research in large sample size for RPOPs prediction models.

Evaluation of transjugular intrahepatic portosystemic shunt and modified sclerotherapy in preventing rebleeding of esophageal and gastric varices.

Esophageal and gastric varices are complications of decompensated portal hypertension due to cirrhosis, and gastrointestinal bleeding and can seriously trigger major bleeding and crisis life. Seriously endangers patients' physical and mental health and attracts great attention in the clinic. To compare the efficacy and safety of MES (combined with lauromacrogol and tissue adhesive) and TIPS in the treatment of esophageal and gastric varices. The 62 cases of esophageal and gastric variceal bleeding in our hospital were retrospectively analyzed. They were divided into the MES group and TIPS group according to the treatment method. The rebleeding rate, complications, 2-year birth rate, treatment cost, and hospitalization time within 2 years after operation were compared between the two groups. Among the 62 patients, there were 32 in the MES group and 30 in the TIPS group. The rebleeding rate within 1 year after operation in the MES group was higher than that in the TIPS group, but the difference was not statistically significant. The rebleeding rate within 2 years after operation in the MES group was 40.63%, significantly higher than 13.33% in the TIPS group (P<0. 05). In the MES group, the incidence of hepatic encephalopathy after the operation was 9.38%, significantly lower than 33.33% in TIPS group (P<0. 05). The survival rate within 2 years after operation in MES group (81.25%) and TIPS group (83.33), the difference was not statistically significant (P>0.05). There was no significant difference in hospital stay between the MES group and TIPS group (P>0.05). The treatment cost of the MES group was lower than that of the TIPS group (P<0.05). MES is more suitable for development and promotion in grass-roots hospitals, but TIPS treatment should be carried out as soon as possible for patients with poor efficacy of endoscopic treatment.

Disease perception and experience in people with diabetic retinopathy: A qualitative study.

The aim of this study was to investigate the lived experience of people with diabetic retinopathy and to understand the impact of the disease on them including the practical problems faced in the day-to-day life. Descriptive qualitative research. A convenience sample of 11 patients with diabetic retinopathy who were hospitalized in a tertiary hospitals in Shandong province of China were enrolled. Data were collected using semi-structured in-depth interviews. The six-stage thematic analysis of Braun and Clarke was used for data analysis. Three themes and 12 sub-themes were extracted, namely: countdown to darkness (lack of disease knowledge, bystander's perspective, distrust of grassroots hospitals); Endless abyss (action restrictions, social isolation, stigma, lost of meaning in life, catastrophizing explanations, a heavy burden); Light chaser (craving for light, turning points in behaviour, self-adjustment).

A Novel Stereotactic Aspiration Technique for Intracerebral Hemorrhage

Minimally invasive surgery is effective and recommended for treatment of intracerebral hemorrhage; however, neurosurgeons in grass-root hospitals in underdeveloped countries lack effective and precise minimally invasive surgery techniques. The aim of this study was to present a technique of computed tomography angiography-based three-dimensional-printed navigation mold-guided stereotactic aspiration and demonstrate its clinical application using a hard needle in a series of patients. The novel stereotactic aspiration technique was performed in 18 patients with spontaneous intracerebral hemorrhage at our center, and clinical outcomes were reported. We compared the volume of hematoma measured by 3 different methods: ABC/2 formula, manual segmentation with OsiriX, and manual segmentation with 3D Slicer. The surgery was completed safely within an average operative time of 15.11 minutes, achieving the goal of <15 mL residual clot volume or >70% clot removal in all patients. No intracranial rebleeding or infection was observed postoperatively. At the end of the 6-month follow-up, 61.11% (11/18) of patients achieved a modified Rankin Scale score <3. There was overall better agreement of hematoma measurement using segmentation with 3D Slicer rather than ABC/2 measurement or hematoma measurement using segmentation with OsiriX. Our novel method of stereotactic aspiration benefited patients in this study with good percent clot removal, few surgery-related complications, and a favorable prognosis. Manual segmentation with 3D Slicer could be used to provide the neurosurgeon with dependable information about hematoma volume. This cheap and convenient technique may be applied in grass-root hospitals in underdeveloped countries. Assessment in multicenter prospective clinical trials is needed.