Objective To investigate the change and significance of T follicular helper cells(Tfh) in the peripheral blood of patients with systemic lupus erythematosus (SLE).Methods The percentage of CD4+ CXCR5+ICOS+ Tfh cells and the expression of activation marker CD69 on the Tfh cells of peripheral blood from 60 SLE patients (30 in active and 30 in inactive) and 30 healthy subjects (control group) were determined by flow cytometry.The correlations between the percentage of Tfh cells of SLE patients and SLE disease activity index (SLEDAI),anti-nuclear antibody (ANA) titers and the levels of complement 3 (C3),complement 4 (C4) were analyzed.ANOVA and Pearson's correlation analysis were used for statistical analysis.Results The percentage of the Tfh cells in the peripheral blood of active SLE patients was higher than inactive patients and healthy controls [(0.80±0.17)％ vs (0.63±0.13)％ vs (0.57±0.08)％; P＜0.01],there was also statistical significance between inactive patients and healthy controls (P＜0.05).The expression of CD69 on the Tfh cells in the peripheral blood of active SLE patients was higher than that in inactive and healthy controls [(7.3±1.6)％ vs (5.9±1.3)％ vs (5.2±0.9)％; P＜0.01].There was no statistical significant difference between inactive patients and healthy controls (P＞0.05).The percentage of Tfh cells of SLE patients was significantly related with SLEDAI (r=0.680,P＜0.01) and C3 levels (r=-0.416,P＜0.05),butthere was no correlation between that and the ANA titer,C4 levels (r=-0.042,-0.204,P＞0.05).Conclusion Increased percentage and activity of the Tfh cells in the peripheral blood of patients might contribute to the pathogenesis and development of SLE.

Objective To assess the application effect of the catheter management software on the management of Indwelling urinary catheter in the Emergency intensive care unit (EICU). Methods A prospective control study of targeted surveillance of catheter-associated urinary tract infection was conducted from January 2014 to December 2015 in EICU. The patients were divided into two groups. The patients in control group (131 patients) were treated from January 1, 2014 to December 31, 2014 and received routine catheter management, and the patients in test group (135 patients) were treated from January 1, 2015 to December 31, 2015, and received catheter management by software. The catheter management software was developed and applied, and the process specification which collaborated with the software was established. The quality of the catheter management including the omission rate of the catheter management, the rate of urinary catheter-associated urinary tract infections (CAUTI) and the rate of catheter used etc were evaluated after the software's application. Results Through software applications, the omission rate of the catheter management, the omission rate of urine drainage bag replacementand the omission rate of urinary catheter replacement in test group were significantly lower than those in control group:0 vs. 36.64%(48/131), 0 vs. 15.27%(20/131) and 0 vs. 9.92%(13/131), P<0.01 or<0.05. The performance rate of catheter daily management in test group was significantly higher than that in control group: 99.26%(134/135) vs. 64.12%(84/131), P<0.01. The rate of CAUTI in test group was significantly lower than that in control group: 1.90‰ vs. 9.16‰, χ2=4.843, P=0.028. The rate of catheter used in test group was significantly lower than that in control group: 60.74%(82/135) vs. 73.28%(96/131), P<0.01. Conclusions The development and the establishment of the management software can improve the rate of implement, and declinethe rate of CAUTI.

Objective To explore the effect of Omaha system nursing model on nutritional status and disease condition of patients with low body mass and chronic obstructive pulmonary disease (COPD). Methods Sixty COPD patients with low body mass who were admitted to the First Affiliated Hospital of Huzhou University from January 2015 to November 2016 were enrolled, and they were randomly divided into an Omaha system nursing model group and a routine care intervention group, with 30 cases in each group. The Delphi expert consultation method was used to construct the Omaha nursing problem system and intervention system for COPD patients with low body mass. The patients in the routine care intervention group were given routine care intervention; the patients in the Omaha system nursing model group underwent nutritional intervention according to the Omaha system nursing model. The Mini Nutritional Assessment (MNA), COPD Assessment Test (CAT) and the modified Medical Research Council Dyspnea Scale (mMRC) were used to be the evaluation system of the Omaha system nursing model, the changes of MNA, CAT and mMRC evaluation scores on admission and in 1, 3, and 6 months after discharge in the two groups were recorded, and the correlations between MNA score and CAT, mMRC scores were analyzed. Results Omaha system analysis showed that the main health problems of the Omaha system nursing model group were distributed in the environmental (17.86%), social psychological (8.93%), physiological (19.64%), and health-related behavioral (53.57%) aspects, among which health-related behaviors were mostly common. There were no statistical significant differences in the scores of CAT, mMRC, and MNA between the two groups on admission (all P > 0.05). The CAT and mMRC scores of the Omaha system nursing model group in 1, 3, and 6 months after discharge were significantly lower than those on admission (CAT score: 16.98±2.39, 16.67±2.55, 15.36±2.17 vs. 25.76±3.67; mMRC score: 2.35±0.57, 1.97±0.52, 1.49±0.51 vs. 3.07±0.55, all P < 0.05), MNA scores were significantly higher than those on admission (11.89±3.57, 13.97±3.52, 15.49±3.51 vs. 10.33±3.02, all P < 0.05), and along with the prolongation of time the decrease and increase in scores were more significant. The scores of the Omaha system nursing model group were improved more significantly in 1, 3 and 6 months after discharge than those of the routine care intervention group (CAT score: 16.98±2.39, 16.67±2.55, 15.36±2.17 vs. 23.01±2.67, 21.15±2.79, 19.06±2.61; mMRC score: 2.35±0.57, 1.97±0.52, 1.49±0.51 vs. 3.06±0.65, 3.06±0.61, 2.65±0.67;MNA score: 11.89±3.57, 13.97±3.52, 15.49±3.51 vs. 9.96±3.15, 10.06±3.09, 8.55±3.17, all P < 0.05]. Pearson correlation analyses showed that MNA score was significantly negatively correlated with CAT score (r = -0.493, P = 0.001) and with mMRC score (r = -0.594, P = 0.001) respectively. Conclusion Using the Omaha system nursing model for nutrition intervention in COPD patients with low body mass can significantly improve their nutritional status and disease condition as well as quality of life.

Objective To observe the missed diagnosis of invasive carcinoma under the microscope (ICUM) in high grade squamous intraepithelial neoplasia (HSIL), and analyze associated factors influencing missed ICUM. Methods A retrospective study was performed on patients diagnosed with HSIL by colposcopy-guided biopsy and treated with loop electrosurgical excision procedure(LEEP)at the First Affiliated Hospital of Nanjing Medical University, from December 2014 to December 2016. They were non-pregnant, ≤50 years old and the cervical volume without obvious enlargement and exogenous surface without and ulcerative lesions. A total of 283 cases with early cervical cytology results, never received cervical traumatic treatment or cervical biopsy in another hospital before, and their colposcopic images were clear enough to reevaluate. The ultimate pathological diagnosis was based on the higher-level pathological diagnosis between the results of cervical biopsy and LEEP to evaluate ICUM missed in HSIL and the risk factors. Results (1) Among the 283 cases with HSIL diagnosed by colposcopy-directed biopsy,44 cases (15.5％,44/283) were missed diagnosis of ICUM, which consisted of 29 cases Ⅰa1, 4 cases Ⅰa2 and 11 cases Ⅰb1 in the ultimate pathology.(2)Analysis of associated factors for missed ICUM:univariate analysis showed that,as the age increased, the risk of missed ICUM also increased(the rates of missed diagnosis for<30, 30-39, 40-50 years were 7.7％, 11.5％, 22.0％, respectively;χ2=6.254, P=0.012 by trend test). The more the number of high-grade features, the higher risks(the rates of missed diagnosis for 1, 2, 3, 4 high-grade features were 10.2％, 17.6％, 23.8％, 30.8％, respectively;χ2=7.686,P=0.006 by trend test). The locations of HSIL were only endocervical, only ectocervical and mixed, the risk increased by this sequence(2.8％, 5.1％, 28.7％; χ2=26.193,P<0.01 by trend test). The rate of missed diagnosis for not completely visible squamocolumnar junction(SCJ)was higher than that of the completely visible one(22.3％ vs 2.1％;χ2=19.680, P<0.01). The rate of missed diagnosis was higher for existing atypical vessels than those without(60.7％ vs 10.6％;χ2=48.279, P<0.01). The rate of missed diagnosis for visible lesion size≥40 mm2 was higher than that of<40 mm2(27.3％vs 4.2％;χ2=28.921, P<0.01). The rate of missed diagnosis for the proportion of visible lesion size in ectocervical size ≥0.75 was higher than that of <0.75 (83.3％ vs 14.1％;P<0.01). The rate of missed diagnosis for the maximum linear length of visible lesion≥10 mm was higher than that of<10 mm(46.9％vs 9.0％;χ2=44.473, P<0.01). But the different severity of cervical cytology before colposcopy was not associated with missed ICUM(P>0.05). Multivariable analysis found that visibility of SCJ, atypical vessels, visible lesion size and maximum linear length of visible lesion were associated with missed diagnosis of ICUM(all P<0.05). Conclusions The diagnostic value of HSIL by colposcopy is limited. Meanwhile, for the patients who are ≤50 years old with HSIL diagnosed by cervical biopsy, invisibility of SCJ, atypical vessels, visible lesion size and maximum linear length of visible lesion evaluated by colposcopy are the independent risk factors of missed ICUM. Thereby, it is necessary to take active intervention for HSIL with these risk factors.

Objective To establish a molecular method for the identification of different serotypes of group B streptococcus(GBS)based on TaqMan fluorescence probe technology,and to lay the foundation for the sub-sequent study of multiple fluorescent probe technology to detect different serotypes of GBS.Methods Primers and probes were designed according to the different serotypes of capsular polysaccharide(CPS).CPS se-quences were amplified by real-time fluorescence quantitative polymerase chain reaction.GBS classification methods of different serotypes were established.The results were compared with latex agglutination test and the method was evaluated from the aspects of sensitivity,specificity and detection of clinical isolates.Results The logarithmic concentration of DNA in the same serotype GBS was linearly correlated with the value of Ct. The detection limit of this method is 1 pg/μL,a probe could only detect the corresponding serotype GBS.The results of TaqMan fluorescence probe test of 10 strains were consistent with the results of latex agglutination test.Conclusion TaqMan fluorescence probe technique is a simple,rapid,highly sensitive and specific method for the detection of different GBS serotypes,and it is better than latex agglutination test for the classification of clinical isolates.

Objective To compare the pulp chamber temperature changes of Nd:YAP laser, Nd:YAG laser and semiconductor laser with the same power during dentin hypersensitivity treatment, and to evaluate the safety of these three laser treatments for dentin hypersensitivity. Methods 50 intact third molars were collected to prepare the dentin hypersensitivity model. The samples were randomly divided into Nd:YAP laser group (n=15), Nd:YAG laser group (n=15), semiconductor laser group (n=15), and blank control group (n=5). Each experimental group was divided into three subgroups (n=5) of 0.9 W, 1.4 W, and 1.8 W according to the laser power. The experiments were conducted with the corresponding laser parameters and thermocouple thermometer was used to record the temperature changes in the pulp chamber. The control group does not do any processing. After laser irradiation, one sample was randomly taken from each group and the morphology of dentin tubules was observed by scanning electron microscopy. Results When different power lasers were used to irradiate the samples, the temperatures of the pulp chamber in each group were increased. Among them, the temperature rise of the pulp chamber was smallest in the Nd:YAP laser group, followed by the semiconductor laser group, and the temperature rise was highest in the Nd:YAG laser group, but it was still lower than 5.5 ° C that could cause pulp necrosis. Scanning electron microscopy results showed that after irradiation with different power lasers, the diameters of most dentinal tubules in the Nd:YAG laser group and the semiconductor laser group were narrowed or even melted, and the effect was better than that of the Nd:YAP laser group. Conclusion The treatment using Nd:YAP laser, Nd:YAG laser and semiconductor laser for dentin hypersensitivity will increase the temperature of the pulp chamber. However, the temperature rise is less than 5.5℃and that will not cause irreversible damage to the pulp tissue. Nd:YAG laser and semiconductor laser have better dentinal tubule blocking effect, which is more suitable for laser dentin desensitization treatment than Nd:YAP laser.

Objective To investigate the change and significance of follicular helper T cells (Tfh) percentage in the peripheral blood of the patients with rheumatoid arthritis (RA).Methods The RA patients treated in this hospital from September to November 2016 were selected and divided into the RA active group and RA stable group,35 cases in each group.Contemporaneous 35 individuals undergoing physical examination were selected as the healthy control group.The percentage of peripheral blood CD4+ CXCR5+ ICOS+ Tfh cells was detected by flow cytometry.The correlations between the percentage of peripheral blood Tfh cells in RA patients with the RA disease activity score 28 (DAS28),anti-CCP antibody and rheumatoid factor(RF) levels were analyzed.Results The percentage of peripheral blood Tfh cells in the RA active group was (0.84±0.16) ％,which was significantly higher than (0.64±0.15)％ in the RA stable group and (0.56±0.14)％ in the healthy control group,the difference was statistically significant (P＜0.01);moreover the percentage of peripheral blood Tfh cells in the RA stable group was also higher than that in the healthy control group (P＜0.05).The percentage of peripheral blood Tfh cells in RA patients had significantly positive correlation with DAS28 score and anti-CCP antibody level (r=0.355,0.324;P＜0.01),and had no correlation with the RF level (r=0.205,P＞0.05).Conclusion The percentage increase of peripheral blood Tfh cells in the patients with RA might be related with the pathogenesis and development of RA.

Objective To analyze the influence of a dental caries phototherapy device using neodymium-yttrium-aluminum-garnet (Nd:YAG) laser on the temperature of tooth pulp chamber of different sites and morphologies under different irradiation duration and power. Methods Fifty intact isolated teeth were collected and randomly divided into middle incisor group, upper right first premolar group, upper right second molar group, upper left first premolar group, and upper left second molar group. Each experimental group was irradiated according to the laser power 1.5, 1.6, 1.7, 1.8, 1.9 and 2.0 W, and the irradiation duration 30, 60, 90 s. The temperature rise of the pulp chamber was recorded with a thermocouple thermometer. Results After the laser irradiation, the temperature of the tooth pulp chamber increased, and the temperature rise was less than 5.5℃, i.e. the threshold leading to the dental pulp necrosis. Conclusions The use of laser to prevent dental caries will increase the temperature of the tooth pulp chamber, but the temperature rise in the range of 5.5 ° C is relatively safe and will not cause irreversible damage to the pulp tissue.

Objective:To analyze the effect of target-oriented treatment based on nutrition-oriented information software on nutritional standards of adult patients with severe traumatic brain injury (sTBI).Methods:Adult patients with sTBI admitted to the department of emergency intensive care unit (EICU) of Huzhou First People's Hospital were enrolled. Taking the online time of information software as the node on March 1st 2019, the patients who underwent early standardized enteral nutrition (EN) process from March 1st 2018 to February 28th 2019 were taken as the control group. The patients who received nutrition management by the nutritional support management system software for critical patients from March 1st 2019 to February 29th 2020 were used as the experimental group. The software was integrated with critical information system software. The effects of nutritional support in two groups were evaluated, including starting time of EN; total energy supply, total protein supply, energy compliance rate on 7 days and 14 days; the total albumin. And the related indicators of critical illness management were evaluated, including the survival rate of intensive care unit (ICU) at 28 days, duration of invasive mechanical ventilation (IMV), successful rates of weaning from IMV, rapid shallow breath index (RSBI) after spontaneous breathing test (SBT), serum cholinesterase on 7 days and 14 days, etc.Results:Fifty-one patients with sTBI were included in the analysis, 28 in the control group and 23 in the experimental group. There were no significant differences in baseline data between the two groups, such as gender, age, body mass index (BMI), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, nutritional risk score (NUTRIC), etc., which were comparable. Compared with the control group, the starting time of EN in experimental group was significantly earlier (hours: 26.82±8.33 vs. 36.73±12.86, P = 0.046). The total protein supply on 7 days and 14 days [g·kg -1·d -1: 1.87 (1.36, 1.92) vs. 1.02 (0.87, 1.67), 2.63 (1.49, 1.92) vs. 1.23 (0.89, 1.92), both P < 0.05], the total energy supply on 14 days (kJ·kg -1·d -1: 154.26±68.16 vs. 117.99±112.42, P = 0.033), the energy compliance rate on 14 days [80.0% (16/20) vs. 35.7% (10/28), P = 0.002], and the serum cholinesterase on 14 days [U/L: 5 792.5 (4 621.0, 8 131.0) vs. 4 689.7 (3 639.0, 7 892.0), P = 0.048] in experimental group were significantly increased. There were no significant differences in other indicators between the two groups [total energy supply on 7 days (kJ·kg -1·d -1): 91.50±30.50 vs. 92.88±28.16, P = 0.184; energy compliance rate on 7 days: 34.7% (8/23) vs. 21.4% (6/28), P = 0.288; total albumin (g): 97.80±46.29 vs. 114.29±52.68, P = 0.086; 28-day survival rate of ICU: 87.0% vs. 78.6%, P = 0.081; duration of IMV (days): 14.33±7.68 vs. 15.68±6.82, P = 0.074; successful rates of weaning from IMV: 69.6% vs. 67.9%, P = 0.895; RSBI after SBT (breaths·min -1·L -1): 26.84±10.69 vs. 33.68±8.94, P = 0.052; serum cholinesterase on 7 days (U/L): 4 289.7 (2 868.0, 7 291.0) vs. 3 762.2 (2 434.0, 6 892.0), P = 0.078]. Conclusion:The development and clinical application of nutrition support information software is helpful for the standardized implementation of the nutritional support treatment process for adult patients with sTBI, which is worthy of further clinical research and promotion.