Objective To investigate the levels of plasma bile acids(BA)in patients with primary liver cancer(PLC)or metastatic liver cancer(MLC)and their correlation with clinical indicators,as well as the value of plasma BAs combined with alpha-fetoprotein(AFP)in the diagnosis of PLC.Methods This study was conducted among 75 patients with PLC and 79 patients with MLC who attended Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2020 to September 2021 and had a confirmed diagnosis based on histopathological and imaging findings.Peripheral blood samples were collected from all patients,and serum and plasma were separated.Colorimetry and chromatography were used to measure biochemical parameters;electrochemiluminescence immunoassay was used to measure the levels of tumor markers;liquid chromatography-tandem mass spectrometry was used to measure the content of BA.The t-test was used for comparison of normally distributed continuous data,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data;the Spearman's coefficient was used for correlation analysis;the receiver operating characteristic(ROC)curve was used to evaluate clinical diagnostic efficacy.Results The PLC group had significantly lower levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol,and apolipoprotein B than the MLC group(U=1 598,1 255,909,and 889,all P＜0.05).Compared with the MLC group,the PLC group had a significantly higher level of AFP and a significantly lower level of carcinoembryonic antigen(U=1 873 and 926,both P＜0.05).Compared with the MLC group,the PLC group had significantly higher levels of TBA,CA,CDCA,UDCA,TCA,TCDCA,GCA,GCDCA,TUDCA,and GUDCA and a significantly lower level of DCA(all P＜0.05).In the total population,the levels of TBA,CDCA,GCA,GCDCA,GUDCA,TCA,TCDCA,and TUDCA were significantly positively correlated with the level of AFP(all P＜0.05).In the patients with PLC,the levels of GCA,TCA,TCDCA,and TUDCA were significantly positively correlated with the level of AFP(all P＜0.05).Combined measurement of AFP+TCA+GCA+TCDCA had an area under the ROC curve of 0.822(95%confidence interval:0.746-0.898,P＜0.000 1),suggesting that it had the highest diagnostic efficacy.Conclusion There are significant differences in the levels of plasma BA between the patients with PLC and those with MLC,and the differentially expressed BAs are closely associated with liver function impairment and the increase in AFP.BAs combined with AFP has a better clinical value in the diagnosis of PLC.

Objective:To investigate the effectiveness of preeclampsia risk prediction models based on maternal risk factors during the first trimester in a local population.Methods:This was a diagnostic study. Pregnant women who underwent prenatal examination in People′s Hospital of Rizhao from May 2019 to May 2022 and had risk factors for preeclampsia were enrolled at 11-13 +6 weeks gestation, and were divided into preterm preeclampsia group, term preeclampsia group and non-preeclampsia group according to the occurrence and the gestational week. Baseline clinical data were collected. The effectiveness of different models in predicting preeclampsia risk was evaluated using receiver operating characteristic (ROC) curves. Results:Among the 559 pregnant women enrolled, 78(14.0%) had preeclampsia, including 35(6.3%) with preterm preeclampsia (preterm preeclampsia group), 43 (7.7%) with term preeclampsia (term preeclampsia group), and 481 (86.0%) without preeclampsia (non-preeclampsia group).The most effective model for predicting preterm preeclampsia in the first trimester was maternal risk factor+mean arterial pressure (MAP)+serum placental growth factor (PLGF)+uterine artery pulse index (UTPI). The area under ROC curve was 0.805, and the sensitivity was 56.6% with a false-positive rate of 10%; the most effective model for predicting term preeclampsia and preeclampsia was maternal risk factor+MAP+UTPI. The area under ROC curve was 0.777, and the sensitivity was 52.6% and 53.5% with a false-positive rate of 10%.Conclusion:The combined predicting strategy for preterm preeclampsia based on maternal risk factors in the first trimester maybe effective among our population.

Objective To analyze the current status of application of clinical decision support system(CDSS)in nursing field,and to provide reference for related research in China.Methods Literature on CDSS in nursing published in the Web of Science core database from January 1,2009 to April 10,2022 was searched.CiteSpace and VOSviewer software were used for visual analysis of journals,countries,key words,etc.Results A total of 2030 literatures were included,and the overall number of publications and citations showed an upward trend.PLoS One was the journal with the highest number of publications,the United States had the highest number of publications,strategies,challenges and burdens were the key words that appeared in recent years.The field had changed from exploratory clinical research to clinical practice,and the challenges and burdens encountered by CDSS in clinical practice and the countermeasures were the current research hotspots.Conclusion Currently,the application of CDSS in clinical care is in its infancy and still faces many challenges,and there is an urgent need for more high-quality research to improve the quality of clinical care and the efficiency of nurses,and to reduce the burden of work.

ObjectiveTo evaluate the clinical efficacy of TDP （specific electromagnetic wave） combined with Osteoking in the treatment of knee osteoarthritis of Qi stagnation and blood stasis type. MethodA total of 104 patients with knee osteoarthritis of Qi stagnation and blood stasis type， who received conservative therapy in The Third People's Hospital of Xinjiang Uygur Autonomous Region from July 2019 to December 2021， were randomized into the control group and study group with the random number table method， 52 cases in either group. The control group was treated with TDP， and the study group with TDP and Osteoking. The treatment lasted 1 week for both groups， with 1-month follow-up. Subjective indexes of visual analog scale （VAS） score and Western Ontario McMaster Universities Osteoarthritis Index （WOMAC） score， and objective indexes of visual tenderness index and visual knee range of motion were determined before and after treatment to evaluate the pain and functions of patients. Traditional Chinese medicine （TCM） syndrome score was calculated. The serum erythrocyte sedimentation rate （ESR） and high sensitivity C-reactive protein （hs-CRP） were detected before and after treatment， and the total clinical effective rate was calculated. ResultBefore treatment， the baseline information and all the scores of the two groups were comparable. After treatment， the VAS score， WOMAC score， tenderness index， knee range of motion， and TCM syndrome score were improved in both groups （P<0.01）. After the treatment， the VAS score and WOMAC score of the study group were lower than those of the control group （P<0.01） and the improvement of tenderness index in the study group was better than that in the control group （P<0.05）. The knee range of motion in the study group was better than that in the control group （P=0.061）. The TCM syndrome score of study group was lower than that of control group （P<0.01） after treatment. The post-treatment serum ESR and hs-CRP level in the two groups decreased significantly after treatment， and the study group were lower than those of the control group （P<0.01）. The total clinical effective rate of the study group was 90.4%（47/52）， as compared with the 53.8%（28/52） in the control group （P<0.05）. No obvious adverse events occurred during treatment in both groups. ConclusionThe clinical efficacy of TDP combined with Osteoking in the treatment of knee osteoarthritis of Qi stagnation and blood stasis type is remarkable， which can improve knee pain and functions， alleviate TCM syndrome， and reduce inflammatory indexes， with high safety.

Objective:To assess the value of ultrasonography in the diagnosis of fetal isomerism syndrome in the first trimester.Methods:Sonographic features of 15 fetuses with isomerism syndrome diagnosed in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2015 to March 2020 were reviewed. Ultrasonic characteristics in the first trimester were analyzed, and the ultrasonic characteristics of early mid-trimester and pathological anatomical results were combined for comparison.Results:There were 6 cases of left isomerism syndrome (LIS) and 9 cases of right isomerism syndrome (RIS) in the 15 fetues.Increased nuchal translucency(NT) (≥3.0 mm, 6 cases), reversed A wave in ductus venosus (10 cases), and atrio-ventricular valve regurgitation (14 cases) were found during the first trimester. There were 14 cases with abnormal visceral laterality. Of the 15 fetues, 14 cases with cardiac malformations, including 6 cases of functional single ventricle, 8 cases of complete atrioventricular septal defect (CAVSD), and 12 cases with great artery abnormalities. All of the 6 LIS cases had bradycardia, 3 cases had interruption of inferior vena cava (IVC). Six cases of RIS had juxtaposition of descending aorta and IVC, and 1 case of RIS had total anomalous pulmonary vein drainage. The major structural malformations were consistent with the early mid-trimester ultrasound examination or autopsy. Karyotype and chromosomal microarray were available in 12 cases and all were normal.Conclusions:Isomerism syndrome has high positive rate of fetal aneuploidies ultrasonographic marker, especially with the atrio-ventricular valve regurgitation, but the risk of chromosome abnormality is low. Ultrasound screening for fetal cardiac structural abnormalities is beneficial to the early diagnosis of isomerism syndrom in the first trimester.

Objective:To explore the feasibility and prognosis of prenatal ultrasonic diagnosis of fetal isolated vascular ring at 11-13 + 6 weeks. Methods:A total of 36 996 fetuses were selected to compare the results of ultrasound screening at 11-13 + 6 weeks and 20-24 weeks of pregnancy in Guangxi Maternity & Child Healthcare Hospital from January 2016 to January 2020, the reasons for missed diagnosis and misdiagnosis of fetal isolated vascular ring by ultrasonography in the first trimester were summarized. Results:Thirty-five cases were diagnosed as isolated vascular ring in the first trimester, including 19 cases right aortic arch combined with aberrant left subclavian artery with "U-shaped" vascular ring, 7 cases double aortic arch with "O-shaped" vascular ring, and 9 cases aberrant right subclavian artery with "C-shaped" vascular ring. While 155 cases were diagnosed as isolated vascular ring at 20-24 weeks of pregnancy, consisting of 18 cases of combined with aberrant left subclavian artery, 9 cases of double aortic arch, 126 cases of aberrant right subclavian artery and 2 cases of pulmonary artery sling, the diagnosis coincidence rates were 94.74%, 77.78%, 7.14%, 0(Kappa value were 0.97, 0.88, 0.13, 0). For the diagnosis of right aortic arch combined with aberrant left subclavian artery, double aortic arch and aberrant right subclavian artery in the first trimester, the specificities were 99.99%, 100%, 100%, the sensitivities were 100%, 77.78%, 7.14%, the false-positive rates were 0.01%, 0, 0, the false-negative rates were 0, 22.22%, 92.86%, and the Youden′s indices were 0.99, 0.78, 0.07.Conclusions:Right aortic arch combined with aberrant left subclavian artery and double aortic arch have high coincidence rate by ultrasonography in the first trimester, while the diagnostic coincidence rate of isolated aberrant right subclavian artery was low. Ultrasound screening for isolated vascular ring in the first trimester still needs ultrasound examination in the second trimester to exclude the minor cardiac malformations that are difficult to diagnose in the first trimester.

Clinical data of 46 patients with trans-sphincter anal fistula treated by fistulectomy with external anal sphincter bareness in Department of Anorectal Surgery, Jiaxing TCM Hospital from July 2018 to July 2019 were retrospectively analyzed. All operations were performed successfully. There were no significant differences in Wexner incontinence scores (2.00±0.68 vs.1.99±0.70, P<0.05), mean anal resting pressure [(75.60±8.60) vs.(73.60±8.20)mmHg(1 mmHg=0.133 kPa), P<0.05] and maximum systolic pressure [(109.60±7.80) vs.(107.20±8.30)mmHg, P<0.05] before and 6 months after operation. There were 1 case with postoperative incision bleeding and 2 cases with postoperative infection. All patients were followed up for 6 months and there was no recurrence and changes in anal shape during the follow-up. Results indicate that the fistulectomy external anal sphincter bareness is safe, efficient with well preserved sphincter function for patients with trans-sphincter anal fistula.

Objective:To analyze the risk factors of modified midline catheter-related thrombosis and propose countermeasures.Methods:Retrospective analysis was used to divide patients admitted to the neurology department of Nanjing Drum Tower Hospital from February 2018 to July 2020 into thrombotic group (9 cases) and nonthrombotic group (117 cases). Univariate analysis and binary Logistic regression were used to analyze the risk factors for catheter-related thrombosis.Results:The incidence of thrombosis was 7.14% (9/126) in patients with modified midline catheters. Univariate analysis showed that the occurrence of catheter-related thrombosis in patients was related to the primary type ( χ2 value was 6.331, P<0.05) and catheter pretreatment ( χ2 value was 4.016, P<0.05). Multivariate analysis showed that there was no significant difference between the primary disease type and the catheter pretreatment method ( P>0.05). Conclusions:The incidence of thrombus in patients with encephalitis and pretreated catheter with normal saline is high, preventive care should be taken before the occurrence of thrombus, and thrombolytic therapy should be taken as soon as possible after the occurrence of thrombus.

Objective:To explore the application and value of metagenomic next-generation sequencing (mNGS) in refractory infection after organ transplantation.Methods:A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed. The recipient was a 63-year-old man with low back pain after kidney transplantation. Lumbar spine magnetic resonance imaging showed lumbar spine infection. Multiple operations plus antibacterial and antituberculosis treatments were ineffective. Before and after treatment, numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results:The detection of lumbar secretion by mNGS suggested aspergillus infection. The symptoms improved after dosing of voriconazole.Conclusions:The incidence of fungal infection of lumbar spine is low. The imaging manifestations are non-typical so that it is easy to misdiagnose. mNGS helps to timely diagnose and guide treatment. With a review of the literature, mNGS has some application value for some difficult and rare infectious diseases.

Objective: Remuzzi scoring system is utilized for assessing the degree of renal tissue damage in donors with hypertensive cerebral hemorrhage and donors with brain trauma after cardiac death. To explore the prognosis of hypertensive cerebral hemorrhage donor kidney in renal transplant recipients. Methods: The kidney donated by DCD between January 1, 2016 to June 1, 2018 were retrospectively reviewed. Pathological biopsy was performed before transplantation and hematoxylin-eosin (HE) staining after sectioning. The degree of renal tissue lesions was evaluated by Remuzzi scoring system. According to the source of donor kidney, they were divided into two groups of donors with heart failure due to hypertensive cerebral hemorrhage (HCH) and those with brain trauma (BT). Both groups of donor kidneys were preserved by low-temperature machine perfusion. The immunosuppressive regimen was identical in both groups. The prognosis of two groups was compared by serum creatinine (Scr) at Month 1/6/12 post-operation and cumulative graft survival rate over a follow-up period of 12-36 months. Results: The renal Remuzzi score of HCH donors was significantly higher than that of BT donors. The maximal creatinine clearance rate was significantly lower than that of BT donors [(86.8±27.8) vs (115.4±23.2) ml/min, P<0.05]. At 1/6/12 months post-transplantation, serum creatinine levels were (76.1±18.5), (72.4±16.2) and (71.4±16.8) μmol/L in BT group and (160.3±33.4), (154.3±32.6) and (146.4±29.1) μmol/L in HCH group. The SCr in BT group at 1/6/12 months was lower than that in HCH group (P<0.05). Kaplan-meier analysis showed no significant inter-group difference in graft survival between two groups over a follow-up period of 12 to 36 months (Log-Rank test, P=0.485). Conclusions No significant difference exists in short-term survival rate of kidneys from HCH and BT donors. The recipients of HCH donor's kidney have higher serum creatinine levels than those of BT donors. Selective use of kidney transplants in patients with cardiac death caused by HCH may greatly reduce the waste of donor kidney and improve the quality-of-life of patients with end-stage renal disease.