OBJECTIVE To evaluate the cause of unqualified level of bacteria in dialysis fluid and to discover(available) resolution measure to select a batter aseptic sampling manipulation.METHODS Spot sampling in dialysis fluid with two methods A and B was used in a hemodialysis unit,1ml was taken to direct culture,and count the(colony).(RESULTS) The finding showed that the cause of unqualified level of bacteria in dialysis fluid focused in types Ⅲ and Ⅳ of(dialyzable) machine,and the average number of bacteria exceeding standard accounted for 18.48% with method B.CONCLUSIONS The contamination in dialysis fluid is related with dialyzable machine and manned(manipulation).

Objectives: To observe the effect of total enteral nutrition (TEN)and total parenteral nutrition (TPN)in aged patients with mechanical ventil ation. Methods: 60 cases of aged patients with mechanical ventilation were randomly divided to TEN group and TPN group.All patients accepted the same amount of calorie and nitrogen. Results: with regard to albumin and hemoglobin levels and nitrogen equilibrium TEN group was superior to parenteral nutrition group ( P 0.05). Conclusions: Enteral nutrition can reduce mechanical ventilation time and lower treatment cost in aged patients.

Objective To explore the clinical application of transvaginal ultrasonography in the diagnosis of intrauterine adhesions .Methods 95 patients with suspected intrauterine adhesions were selected as the study subjects.All patients were treated with vaginal two -dimensional,three-dimensional ultrasound,and the results and hysteroscopy results were compared .The sensitivity,specificity,positive predictive value ,negative predictive value and accuracy of two -dimensional and three -dimensional ultrasonography were analyzed .Results Of 95 cases with suspected intrauterine adhesions ,vaginal two -dimensional ultrasound diagnosed 54 cases of intrauterine adhesions , including 30 cases of mild adhesion ,18 cases of moderate adhesion ,6 cases of severe adhesion ,22 cases of missed diagnosis or misdiagnosis.Compared with hysteroscopy ,the difference was statistically significant (χ2 =12.213,P=0.007).Three -dimensional ultrasound diagnosed intrauterine adhesions in 63 cases,including 20 cases of mild adhesion ,35 cases of moderate adhesion ,8 cases of severe adhesion ,only 7 cases of missed diagnosis or misdiagnosis . Compared with hysteroscopy ,the difference was not statistically significant (χ2 =0.630,P=0.889),suggested that the diagnosis of vaginal three -dimensional ultrasound and hysteroscopy results was consistent , and vginal three -dimensional ultrasound was superior than two -dimensional ultrasound , the difference was statistically significant (χ2 =8.848,P=0.003).The sensitivity of transvaginal two -dimensional ultrasonography in diagnosis of intrauterine adhesions was 67.65％,which of three-dimensional ultrasound was 89.71％,there was statistically significant differ-ence between the two groups (χ2 =9.861,P=0.002).The specificity of two-dimensional ultrasound was 70.37％, which of three-dimensional ultrasound was 92.59％,there was significant difference between the two groups (χ2 =4.418,P=0.036).The positive predictive value of two -dimensional ultrasound was 85.19％,which of three -dimensional ultrasound was 96.83％,there was statistically significant difference between the two groups (χ2 =5.040, P=0.025).The negative predictive value of two -dimensional ultrasound was 46.34％,which of three-dimensional ultrasound was 78.13％, there was statistically significant difference between the two groups (χ2 =7.583, P =0.006).The diagnostic accuracy of two -dimensional ultrasound was 68.42％,which of three -dimensional ultra-sound was 90.53％,there was statistically significant difference between the two groups (χ2 =14.228,P=0.000). Conclusion Transvaginal three-dimensional ultrasound in diagnosis of intrauterine adhesions is more accurate than two-dimensional ultrasound , and the result is consistent with hysteroscopy .Transvaginal three -dimensional ultra-sound can be used as the preferred method of intrauterine adhesions .

Objective To explore the influence of family-integrated transition care on the daily living ability of discharged patients with stroke.Methods Seventy-eight patients with stroke who were admitted to Renmin Hospital of Wuhan University from May 2016 to October 2017 were selected by convenience sampling and were divided into a control group and a family-integrated transition care group (hereinafter referred to as transition care group).The patients in the control group received routine neurological health education,while those in the transition care group received a family-integrated transition care intervention in addition to routine neurological health education.The family-integrated transition care included team building,skills training for family members,family-integrated guidance for discharged patients,and regular visits.The scores of the modified Barthel index were compared between the two groups of patients at discharge,three months after intervention,and six months after intervention.Results Among the 71 patients that were finally included,35 cases were included in the control group,of which 17 cases were men (49％),18 cases were women (51％),and their mean age was (70.1±3.7) years;the transition care group comprised 36 cases,of which 18 cases were men (50％),18 cases were women (50％),and their mean age was (69.8±4.5) years.The baseline scores of the control group and transition care group on the day of discharge were (49.1 ± 7.5) and (49.7 ± 7.9),respectively,with no significant difference (P＞0.05).In terms of time effects,the scores of the patients in the two groups had statistically significantly improved at six months after discharge (P＜0.05).In the group comparison,the scores of the patients in the transition care group after the intervention were significantly higher compared to the scores of those in the control group (P＜0.05).In terms of time and inter-group effects,there was an interaction (P＜0.05),and therefore,the influence of time effects was excluded and the same timepoint was compared between the two groups.The scores at three months (63.9±8.8) and six months (76.9± 10.1) in the transition care group were higher than those in the control group (58.1 ±8.1 and 66.0 ±9.3,respectively).The difference was statistically significant (P ＜ 0.05).Conclusion Family-integrated transition care can effectively improve daily living ability and isworthy of promoting.

Objective:To explore expression patterns of transcription factor TFAP2B in epidermal melanocytes of healthy individuals and vitiligo patients.Methods:Lesional tissues were collected from 5 patients confirmedly diagnosed with progressive vitiligo at the Department of Dermatology, Xijing Hospital, Air Force Medical University from January 2020 to December 2022. At the same time, some discarded normal skin tissues were obtained from 5 gender- and age-matched healthy individuals after plastic surgeries. The immortalized healthy human epidermal melanocyte cell line PIG1, the vitiligo epidermal melanocyte cell line PIG3V, and primary human epidermal melanocytes, which were isolated from the discarded foreskin tissues of 3 healthy males after urological surgeries in Xijing Hospital, were cultured in vitro. Tissue immunofluorescence assay was performed to determine the expression and localization of TFAP2B and dopachrome tautomerase (DCT) in healthy skin tissues and vitiligo lesions, and cell immunofluorescence assay and Western blot analysis were conducted to determine the TFAP2B expression in human epidermal melanocytes. Comparisons between two groups were performed using t test, and correlation analysis was performed using Pearson correlation coefficients. Results:Tissue immunofluorescence assay showed that TFAP2B was specifically expressed in human epidermal melanocytes and localized in the nuclei. Western blot analysis showed that TFAP2B was strongly expressed in the human epidermal melanocyte cell line PIG1 and primary melanocytes, with the relative expression levels being 0.45 ± 0.05 and 0.36 ± 0.04, respectively. Tissue immunofluorescence analysis showed that the fluorescence intensity of TFAP2B (623 917.5 ± 88 784.0) was significantly and positively correlated with that of DCT (2 232 655.3 ± 588 810.4; r = 0.91, P < 0.001) in human epidermal tissues from 5 healthy controls and 5 vitiligo patients. In addition, the relative fluorescence intensity of TFAP2B in epidermal melanocytes was significantly lower in the vitiligo lesions (0.12 ± 0.05) than in the healthy skin tissues (1, t = 19.35, P < 0.001). Western blot analysis showed that the relative expression level of TFAP2B was also significantly lower in the PIG3V cells (0.62 ± 0.09) than in the PIG1 cells (1, t = 5.92, P < 0.027) . Conclusions:TFAP2B was specifically and highly expressed in human epidermal melanocytes, and its expression level was significantly and positively correlated with that of the melanocyte marker DCT. Additionally, TFAP2B was obviously lowly expressed in the epidermal melanocytes of patients with vitiligo.

Objective:To analyze risk factors for diabetes mellitus in patients with vitiligo, and to construct and validate a prediction model.Methods:A total of 110 vitiligo patients with diabetes mellitus (comorbidity group) and 4 505 vitiligo patients without diabetes mellitus (control group) were collected from the medical record database in Xijing Hospital, the Fourth Military Medical University from January 2010 to October 2021, and matched for gender and age at a ratio of 1∶4 by using a propensity score method. After matching, the matched pairs were randomly divided into a training set and a test set at a ratio of 4∶1. Univariate and multivariate logistic regression analyses were used to assess demographic and clinical characteristics of patients in the training set, screen differential factors, and construct a prediction model. A five-fold cross-validation method was used for internal validation after construction of the prediction model. The discrimination (area under the curve [AUC]) , calibration (Hosmer-Lemeshow test) and accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of the prediction model were evaluated in the test set.Results:A total of 107 cases in the comorbidity group and 428 cases in the control group were successfully matched. The training set included 430 cases, and the test set included 105 cases. Based on multivariate logistic regression results, a total of 6 factors were included in the prediction model, including course of vitiligo (odds ratio [ OR] = 1.04, 95% confidence interval [ CI]: 1.02 - 1.07, P<0.001) , high-sugar/high-fat/high-salt diet ( OR = 3.19, 95% CI: 1.38 - 7.38, P = 0.007) , family history of diabetes ( OR = 23.23, 95% CI: 9.72 - 55.50, P<0.001) , metabolic comorbidities ( OR = 12.53, 95% CI: 5.60 - 28.07, P<0.001) , autoimmune comorbidities ( OR = 5.89, 95% CI: 2.52 - 13.76, P<0.001) , and acral vitiligo ( OR = 3.84, 95% CI: 1.45 - 10.19, P = 0.007) . Five-fold cross-validation results showed a good predictive performance of the prediction model, with the AUC being 0.902 (95% CI: 0.864 - 0.940) in the training set and 0.895 (95% CI: 0.815 - 0.974) in the test set. The prediction model also showed favourable discrimination (AUC =0.814, 95% CI: 0.715 - 0.913) , calibration (Hosmer-Lemeshow test, P = 0.068) , and accuracy (sensitivity = 0.810, 95% CI: 0.574 - 0.937; specificity = 0.786, 95% CI: 0.680 - 0.865; positive predictive value = 0.486, 95% CI: 0.317 - 0.657; negative predictive value = 0.943, 95% CI: 0.853 - 0.982) in the test set. Conclusion:A risk prediction model was constructed for diabetes mellitus in patients with vitiligo based on 6 factors (course of vitiligo, high-sugar/high-fat/high-salt diet, family history of diabetes, metabolic comorbidities, autoimmune comorbidities, and acral vitiligo) , which showed favourable discrimination, calibration and accuracy, and might provide a reference for screening the high-risk diabetic population in vitiligo patients.

Objective To investigate the analgesic effect of different concentrations of medetomidine and ropivacaine on knee arthroscopy in elderly patients in the orthopedics department. Methods 72 patients were di-vided into 4 groups,and from February 2016-September 2017 ,different concentrations of dexmedetomidin and ropivacaine were given to the patients after the operation,and compared the analgesic effects and adverse reactions of each group. Results The duration of analgesia in groups C and D were longer than group A and B and there were significant differences in the amount of fentanyl in the 4 groups after 24 h(F = 79.633,P < 0.05 )and there was no significant difference in the incidence of adverse reactions between the 4 groups(P > 0.05);1,3,6, 10,16,24 h after operation,The VAS scores in group C and D were significantly lower than those in group A and B(P < 0.05 ). Conclusion Dexmedetomidine plus ropivacaine can effectively improve the analgesic effect after knee arthroscopy,0.50 g/kg was the best concentration of dexmedetomidin.

ObjectiveBased on ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS^E） technique， we identified qualitatively the metabolites of aristolochic acid（AAs） in rat in order to analyze the metabolic differences between water extract of Aristolochiae fructus（AFE） and Aristolochic acid Ⅰ（AAⅠ）. MethodSD rats were selected and administered AFE（110 g·kg^-1·d^-1） or AAⅠ（5 mg·kg^-1·d^-1） by oral for 5 days， respectively. Serum， urine and feces were collected after administration. Through sample pretreatment， ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm） was used with the mobile phase of 0.01% formic acid methanol（A）-0.01% formic acid water（B， containing 5 mmol·L^-1 ammonium acetate） for gradient elution（0-1 min， 10%B； 1-7 min， 10%-75%B； 7-7.2 min， 75%-95%B； 7.2-10.2 min， 95%B； 10.2-10.3 min， 95%-10%B； 10.3-12 min， 10%B） at a flow rate of 0.3 mL·min^-1. Positive ion mode of electrospray ionization（ESI⁺） was performed in the scanning range of m/z 100-1 200. In combination with UNIFI 1.9.4.053 system， the Pathway-MS^E was used to qualitatively analyze and identify the AAs prototype and related metabolites in biological samples（serum， urine and feces）， and to compare the similarities and differences of metabolites in rats in the subacute toxicity test between AFE group and AAⅠ group. ResultCompared with AAⅠ group， 6， 10， 13 common metabolites and 14， 20， 30 unique metabolites were identified in biological samples（serum， urine and feces） of AFE group， respectively. Moreover， the main AAs components always followed the metabolic processes of demethylation， nitrate reduction and conjugation. Compared with common metabolites in AAⅠ group， prototype components of AAⅠ in serum and most metabolic derivatives of AAⅠ［AAⅠa， aristolochic lactam Ⅰ（ALⅠ）a， 7-OHALⅠ and its conjugated derivatives］ in biological samples were significantly increased in AFE group（P<0.05， P<0.01）， except that the metabolic amount of ALⅠ in feces of AFE group was remarkably lowed than that of AAⅠ group（P<0.01）. In addition， a variety of special ALⅠ efflux derivatives were also identified in the urine and feces of the AFE group. ConclusionAlthough major AAs components in AFE all show similar metabolic rules as AAⅠ components in vivo， the coexistence of multiple AAs components in Aristolochiae Fructus may affect the metabolism of AAⅠ， and achieve the attenuating effect by increasing the metabolic effection of AAⅠ and ALⅠ.