OBJECTIVETo evaluate the changes in the renal function of patients with chronic hepatitis B (CHB) receiving adefovir dipivoxil (ADV) or telbivudine (L-DT) monotherapy.

METHODSThis retrospective analysis involved 101 patients with CHB and liver cirrhosis receiving either ADV or L-DT monotherapy for 52 weeks. Serum creatinine, estimates of glomerular filtration rate (eGFR), and the percentage of patients with eGFR≥90 ml·min(-1)·1.73 m(-2) at week 52 were compared with the baseline data between the two groups.

RESULTSThe mean changes of CR at week 52 from baseline were +0.05 mg/dl in ADV group and -0.12 mg/dl in L-DT group, showing a significant difference between the two groups (P=0.000). No patient was found to have an elevation of creatinine over 0.50 mg/dl. The median change of eGFR at week 52 from baseline differed significantly between ADV and L-DT groups (-4.09 vs+18.32 ml·min(-1)·1.73 m(-2), P=0.000). Ninety-two percent (12/13) of the patients with baseline eGFR<90 ml·min(-1)·1.73 m(-2) shifted to eGFR ≥90 ml·min(-1)·1.73 m(-2) after 52 weeks of L-DT treatment, as compared to 38% (3/8) in ADV group. The proportion of patients with eGFR≥90 ml·min(-1)·1.73 m(-2) in L-DT group increased from 76.36% (42/55) at baseline to 94.55% (52/55) at week 52, while that in ADV group decreased from 82.61% (38/46) at baseline to 78.26% (36/46). The constituent ratios of eGFR at different levels were similar at baseline (P=0.443) but significantly different at week 52 between the two groups (P=0.015).

CONCLUSIONL-DT treatment is associated with a renoprotective effect in patients with CHB, but the mechanism remains unclear.

Adenine ; analogs & derivatives ; therapeutic use ; Adolescent ; Adult ; Creatinine ; blood ; Female ; Glomerular Filtration Rate ; Hepatitis B, Chronic ; drug therapy ; physiopathology ; Humans ; Male ; Middle Aged ; Organophosphonates ; therapeutic use ; Retrospective Studies ; Thymidine ; analogs & derivatives ; therapeutic use ; Young Adult

Objective To investigate the effects of different umbilical cord ligation methods on anemia and jaundice in preterm infants with a gestational age less than 32 weeks.Methods A total of 135 preterm infants with a gestational age less than 32 weeks were recruited and randomly divided into the umbilical cord milking group,the delayed cord clamping group and the immediate cord clamping group,with 45 cases in each group.Comparisons among three groups were performed on hemoglobin,hematocrit at 1 h and 1 week after birth,and bilirubin peak,total time of phototherapy,the incidence of anemia,pathologic jaundice as well as polycythemia before discharge.Results Finally 40 cases in the umbilical cord milking group,42 cases in the delayed cord clamping group and 38 cases in the immediate cord clamping group were recruited.Compared with the immediate cord clamping group,Hb(g/L)and hematocrit(％) levels were significantly higher in the umbilical cord milking group and the delayed cord clamping group(P＜0.05),the anemia rate was significantly lower in umbilical cord milking group and the delayed cord clamping group(P＜0.05).However,there were no statistical differences in Hb(g/L) and hematocrit(％) levels as well as ane mia rate between the umbilical cord milking group and the delayed cord clamping group (P＞0.05).There were no significant differences among three groups in bilirubin peak,total time of phototherapy and the incidence of pathologic jaundice as well as polycythemia.Conclusion Umbilical cord milking and delayed cord clamping can both reduce the anemia rate,but not increase the risk of pathological jaundice.Umbilical cord milking can be preferred method for preterm infants with a gestational age less than 32 weeks and asphyxia.

Objective:To explore the current status and the influencing factors of protracted postpartum urinary retention(P-PUR) in women with labor analgesia, so as to provide evidences for early diagnosis and timely intervention for P-PUR.Methods:A total of 41 995 women who were given vaginal delivery under labor analgesia from January 2017 to October 2020 in Women′s Hospital of Nanjing Medical University were chosen as the research objects. A retrospective analysis was performed for the clinical data of 62 women with P-PUR, and a 1∶4 matching case control study was conducted. Logistic regression analysis was used to analyze the variables with statistical difference in univariate analysis, so as to explore the independent influencing factors of P-PUR in women with labor analgesia.Results:Among 41 995 women with labor analgesia, 62 women suffered from P-PUR, and the incidence was about 0.15% (62/41 995). The Logistic regression model showed that nulliparity ( OR=121.80, 95% CI 8.59-1 727.40, P<0.05), forceps delivery ( OR=13.41, 95% CI 2.21-81.58, P<0.05),Ⅱdegree porineal iaceration ( OR=0.04, 95% CI 0.01-0.11, P<0.05), episiotomy ( OR=0.13, 95% CI 0.04-0.47, P<0.05) and perineotomy with perineal laceration ( OR=0.20, 95% CI 0.06-0.63, P<0.05) were the independent risk factors. Conclusions:For primiparas with labor analgesia, interventions should be taken to reduce perineal injury, and indications of forceps delivery should be strictly controlled, so as to reduce P-PUR and adverse urinary tract complications.

Objective:To explore the application effects of a new self-designed device for measuring postpartum blood loss in women with postpartum hemorrhage after vaginal delivery, so as to provide a basis for early identification and treatment of postpartum hemorrhage.Methods:The research was a quasi-experiment study. A total of 12 824 women who delivered vaginally in Women's Hospital of Nanjing Medical University from July 2021 to June 2022 were conveniently selected. Among them, the pregnant women enrolled from January to June 2022 were selected as the experimental group, and the pregnant women enrolled from July to December 2021 were included in the control group, with 6 412 cases in each group. The self-designed new postpartum blood loss measuring device was used to evaluate the blood loss in the experimental group, while the traditional blood collecting basin was taken in the control group.The differences between the two groups in the assessment error of 24 hours postpartum blood loss, postpartum blood loss at 2 hours and 24 hours, postpartum hemorrhage rate, severe postpartum hemorrhage rate and midwives′ satisfaction with the assessment of blood loss were compared.Results:The assessment error of 24 hours postpartum blood loss in the experimental group was 180.00 (80.00, 300.00) ml, which was lower than 192.00 (80.00, 310.00) ml in the control group, and the difference was statistically significant ( Z = - 2.04, P<0.05). The postpartum blood loss at 2 hours and 24 hours in the experimental group was 312.00 (290.00, 330.00) ml and 415.00 (385.00, 440.00) ml, respectively, which was higher than 310.00 (280.00, 330.00) ml and 407.00 (380.00, 435.00) ml in the control group, and the differences were statistically significant ( Z = - 9.86, - 5.42, both P<0.001). The rates of postpartum hemorrhage and severe postpartum hemorrhage in the experimental group were 6.50% (417/6 412) and 2.21% (142/6 412), respectively, higher than 4.71% (302/6 412) and 1.59% (102/6 412) in the control group, and the differences were statistically significant ( χ2 = 19.49, 6.69, both P<0.05). Midwives′ satisfaction score with the assessment of blood loss in the experimental group was (18.17 ± 1.02) points, higher than that in the control group (17.78 ± 1.17) points, and the difference was statistically significant ( t = 2.33, P<0.05). Conclusions:The use of a new device for measuring postpartum bleeding during vaginal delivery can reduce errors in evaluating postpartum blood loss within 24 hours, improve the detection rate of postpartum hemorrhage and severe postpartum hemorrhage, and midwives are satisfied with it.

Objective:The classification model of prognosis of elderly cancer patients in rural areas of Shaanxi province was constructed based on machine learning algorithm, and its effectiveness was verified, providing reference for early prognosis recognition and intervention treatment.Methods:Using a multicenter, cross-sectional survey method and convenience sampling method, 597 elderly cancer patients in rural areas hospitalized in 9 different medical institutions (Shaanxi Cancer Hospital and its member units of specialty alliance) in Shaanxi Province from July to August 2022 were selected as the research objects, and a variable database of "basic information", "self-care ability", "symptoms", "comprehensive needs" and "quality of life" of elderly cancer patients in rural areas was established. Machine learning and statistical analysis were carried out to explore the important prognostic characteristics of elderly cancer patients in rural areas, and a prognostic classification model for elderly cancer patients in rural areas was constructed and verified.Results:The 597 valid questionnaires were ultimately collected.Among the 597 elderly cancer patients in rural areas, 207 were males and 390 were females, aged (69.56 ± 8.84) years. The results of cluster exploration showed that the prognosis of elderly cancer patients in rural areas was divided into three categories: good, medium and poor. The areas under the working characteristic curves of the subjects in good, medium and poor were 0.84, 0.79 and 0.69, respectively. The results of characteristic exploration showed that 10 indicators of "whether accompanied by metastasis", "distress", "sadness", "numbness", "eating", "walking", "fatigue", "forgetfulness", "fun of life" and "relationship with others" were important characteristic indicators of prognosis evaluation of elderly cancer patients in rural areas. There were statistically significant differences among the 10 important characteristic indicators in the three categories of prognosis of rural elderly cancer patients ( χ2=21.07, H values were 18.51-144.38, all P<0.01). There were statistically significant differences in the three categories of "comprehensive needs", "quality of life", "self-care ability" and "symptoms" ( H values were 519.40, 40.80, 103.69, all P<0.01). Conclusions:The construction and verification of a prognostic classification model for elderly cancer patients in rural areas based on machine learning algorithm can effectively explore the important characteristic indicators and prognostic classification of elderly cancer patients in rural areas, and provide basis and guidance for clinical medical staff to make individualized plans.

Objective To construct the nursing quality sensitive index of midwifery applicable for delivery room, so as to provide a basis for evaluating and monitoring nursing quality of delivery room. Methods The literature review was used to preliminarily draw up the sensitive indicators framework. Delphi method involved with internal enquiry and experts enquiry was used to define the key content and measuring methods. Results The experts' authority coefficient was higher than 0.80 and the coefficient of variation of the index was lower than 0.30. We constructed a nursing quality sensitive index system of midwifery including three first-level indicators and 16 second-level indicators by two rounds of expert consultation. Conclusions The nursing quality sensitive index of midwifery based on Delphi method is with sensibility, scientific nature and practicability which can promote the sustained development of delivery room.

Objective To investigate current status in knowledge,attitude and practice(KAP)of transitional care among the nurses in Shaanxi province,identify the influencing factors that hinder the transitional care and carry out training of transitional care for the nurses in different specialties in order to provide a theoretical basis for establishing a transitional care model for discharged patients.Methods A total of 2 288 nurses were selected to participate the survey from 41 hospitals in Shaanxi province by the stratified two-stage random sampling method.A self-designed questionnaire for general information,an obstacle factor scale,and a KAP of transitional care questionnaire were used as the survey instruments.The data acquired from the survey were processed by Cluster analysis to identify potential categories and the influencing factors.Results Totally 2085 nurses finished the study.Total score of KAP of transitional care among the nurses in Shaanxi province was found at(134.96±23.75),which was at a medium level.The scores of knowledge,attitude and practice were 77.24%,80.64%and 76.98%respectively.Cluster analysis showed that all the nurses could be categorised into either a lower scored group(n=1 596,76.5%)or a higher scored group(489,23.5%),with a best potential category number of 2 for the 2 085 nurses who participated the survey.There were statistically significant differences between the groups in terms of care training,telephone follow-up,network platform,outpatient service of nursing experts,family visits,patient club and hospital categories(all P＜0.05).Logistic regression analysis on even factors above showed that care training,telephone follow-up,network platform and patient club could significantly affect the potential categorisation of KAP of the nurses in transitional care(all P＜0.05).The main factors that hindered the transitional care included insufficient human resources(93.81%),insufficient supply of community services(93.57%)and lack of a standardised flowchart for transitional care(93.09%).Conclusions Levels of KAP about the transitional care are at a medium level among the nurses of 41 hospitals in Shaanxi province,which indicates that the nurses are active in attitude,but the knowledge and practice are required to be further improved and standardised.The results of cluster analysis indicate that it is necessary for nursing managers to carry out targeted trainings in transitional care for the nurses in different categories.This study provides a theoretical basis to establish a diversified transitional care mode for discharged patients in Shaanxi province.

Objective: Molecular genetics and clinical phenotypic characteristics of 5 alpha reductase deficiency were analyzed. Methods: The genetic results and clinical features classied as Prader grade of external genitalia of 86 children with SRD5A2 mutation seen from 2007 to 2017 at Department of Endocrinology of Beijing Children′s Hospital were analyzed, and the mutation differences in different were compared regions according to the literatures. Results: Among the 86 children, 15 had were homozygous mutations, accounting for 17%, and 71 cases of compound heterozygous mutations accounted for 83%. Totally 172 alleles mutations in this series. The mutation was mainly located on exon 1 and exon 4, in which the mutation frequency of exon 1 was 23.8% (41/172), and the frequency of exon 4 mutation was 55.8% (96/172). A total of 19 mutation types of the SRD5A2 gene in this group were detected, of which 5 were new mutations (p.A228F, p.E57D, p.V124D, p.A117D, p.E197K); 65 patients had p.R227Q mutation, accounting for 76%, while 31 had p.Q6* mutation, accounting for 36%. Other rare types such as p.R246W, p.R103* and so on were also seen in the present study, there was no significant difference between north China and south China (P>0.05). The clinical phenotypes of p.R227Q variation varied, mainly in Prader 3-4, accounting for 82%, while (Prader 0-1) were less, accounting only 2%. The variation of p.Q6* was mainly manifested in Prader 3, accounting for 50%. p.R246Q mainly presented Prader 3. The variation of p.G203S appeared to have Prader 2 and Prader 4-5, accounting for 20% and 73% respectively. There was no significant difference in clinical phenotype corresponding to each protein type (P>0.05) . Conclusion Among the 86 children have identified 19 SRD5A2 mutation types, p.R227Q is a hotspot mutation in Chinese. Variations at different types may have different clinical phenotypes, while the same variations may have different clinical features. There was no significance different in the variation types between the north and the south.

Objective:To investigate the efficacy and safety of oral testosterone therapy in individuals diagnosed with androgen insensitivity syndrome (AIS).Methods:A self-controlled study design was utilized, focusing on individuals with AIS who were genetically diagnosed at the Department of Endocrinology, Genetics, and Metabolism of Beijing Children′s Hospital between 2009 and 2021. These patients underwent treatment involving the administration of testosterone. The primary observed indexes include the measurement of penis length, which should meet the minimal surgical standard (penis length≥2.5 cm) or greater than or equal to -2.5 s (lower limit of normal). Secondary observed indexes include penile length standard deviation score (PL-SDS), an increase in penis longitude (ΔPL), medication dosage, the course of therapy, and safety indicators, among others. There were 4 courses of treatment. After each course, patients were evaluated to determine whether termination of treatment was appropriate. Patients who exhibited inadequate post-treatment penile length growth were advised to continue with further treatment. The statistical methodology included t-test, and a Wilcoxon rank sum test to describe efficacy and safety. The patients were followed up until 2023. Results:The study comprised a total of 51 individuals with AIS, comprising 33 males and 18 females (gender of registered permanent residence). Among these patients, 10 were diagnosed with complete androgen insensitivity syndrome (CAIS) and 41 were diagnosed with partial androgen insensitive syndrome (PAIS). There were 2 children with CAIS were diagnosed by doctors and prescribed testosterone undecanoate, but the children did not really take medicine.The penile length of CAIS patients could not be measured (penile length<0.5 cm) before and after treatment. For PAIS patients, baseline penile length and PL-SDS were (2.3±0.6) cm and -3.7±1.3, respectively. The measurements for penile length and PL-SDS after each treatment course were recorded as follows: (2.7±0.8), (2.8±0.6), (2.6±0.4), (2.6±0.4) cm and -2.8±1.6, 2.5±1.6, 2.9±1.2, -3.2±0.9, respectively. Both penile length and PL-SDS interventions showed statistically significant gains when compared to the baseline performance of the 4 courses ( t=4.05、3.56、2.55、2.23 and 3.88、3.50、2.50、2.19, all P<0.05). Before treatment, 13 PAIS patients (32%) reached 2.5 cm and seven (17%) reached greater than or equal to -2.5 s. Following the initial, subsequent, third, and fourth therapeutic interventions, 18 cases (44%), 24 cases (59%), 25 cases (61%), and 26 cases (63%) reached 2.5 cm, respectively. Additionally, A total of 12 cases (29%), 15 cases (37%), 20 cases (49%), and 21 cases (51%), respectively, were found to reach greater than or equal to -2.5 s. The study involved the longitudinal monitoring of patients with the highest recorded age being 13.7 years. The weight, height, body mass index, bone age/age, cholesterol, hemoglobin and so on were all within the normal range and the difference were not statistically significant (all P>0.05). All 49 patients were no abnormalities in blood electrolyte, liver and kidney function and thyroid function and no changes in precocious puberty, pubic hair growth, aggressive behavior, vulvar skin darkening, diarrhea or other conditions. Conclusions:Testosterone undecanote in children with CAIS was no effective. The initial course of treatment for patients with PAIS demonstrates observable enhancements in penile length and PL-SDS. For patients with inadequate penile length growth, continued treatment in subsequent courses (such as the second, third, and fourth courses) is recommended toenhance outcomes gradually. Testosterone undecanoate was safe and effective for the majority of individuals with PAIS patients, with few adverse effects and good treatment tolerance.

Objective: To investigate the prevalence and risk factors of non-alcoholic fatty liver disease(NAFLD) in patients with chronic hepatitis B(CHB) receiving antiviral treatment. Methods: The cross-sectional study included 3 477 cases with CHB who received antiviral therapy. The prevalence of NAFLD was investigated, and then the risk factors were screened and analyzed by stepwise regression method in CHB patients with NAFLD as the dependent variable and the related influencing factors as independent variables. Results: The prevalence of NAFLD was 24.1% in CHB patients who received antiviral therapy. After adjusting for age and gender, central obesity (OR: 7.44, 95%CI: 6.06 ~ 9.14), hypertension (OR: 1.74, 95%CI: 1.51 ~ 2.20), and triglyceride (OR: 1.52, 95%CI: 1.18 ~ 1.96) were positively associated with NAFLD, and cirrhosis was negatively associated with NAFLD (OR: 0.42, 95%CI: 0.34 ~ 0.53). Patients with long-term antiviral therapy had increased risk of NAFLD. Conclusion A significant proportion of CHB patients receiving antiviral therapy have suffered from NAFLD. Therefore, CHB patients receiving long-term antiviral treatment should pay more attention to the prevalence of NAFLD.