Objective To investigate the clinical efficacy of the optimization of treatment with lamivudine or de novo combination therapy with lamivudine and adefovir dipivoxil.Methods A total of 98 cases of chronic hepatitis B patients were randomly divided into optimization of treatment group and de novo combination therapy group,optimization of treatment group treated with lamivudine optimization therapy,de novo combination therapy group treated with lamivudine and adefovir dipivoxil,virological,serological,biochemical and other indices were detected every 12 weeks,analyzed treatment effect after 48 weeks.Results Two groups were comparable baseline before treatment(P ＞0.05).HBV DNA negative rate,e antigen-negative rate,and resistance rates at week 48 were 86％,37％,and 0 in the de novo combination therapy group,and 59％,12％ and 18％ in the optimized treatment group (P ＜0.05).The e antigen seroconversion and ALT normalization rates were 23％ and 91％ in the de novo combination group,and 6％ and 86％ in the optimized treatment group (P ＞0.05).There was similar incidence of adverse reactions.Conclusions Compared to the de novo combination therapy group,the lamivudine-optimized treatment group can achieve higher HBV-DNA negative rate,e antigen-negative rate,lower resistance rates,and good safety.

Objective To observe the efficacy of the photon therapeutic apparatus on wound healing .Methods Totally 60 patients who had received the operation for their ischial tuberosity cysts were randomly divided into observation group and control group ,30 cases each in each group .The control group received conventional dressing change .The observation group received con-ventional treatment on the basis of the application of photon therapeutic apparatus for adjuvant therapy ,2 times a day ,7 days a course of treatment .Both of groups had the same other treatment and nursing care .The clinical efficacy of the two groups was ob-served .Results After the 4 and 7 days of treatment ,the observation group was superior to the control group on pain level ,content of extravasate(P< 0 .05) .The healing time of observation group was less than control group(P< 0 .01) .Conclusion The photon therapy is effective in the treatment of wound healing of patients with ischial tuberosity cysts after operation .

Through the hemodialysis machine and water treatment systems maintenance, the result of complications caused by dialysis can be eliminated. It also of extended the life of hemodialysis machines and improve the quality of dialysis.
Equipment Failure ; Equipment and Supplies ; standards ; Humans ; Maintenance ; Renal Dialysis ; adverse effects ; instrumentation ; Water Supply ; standards

Objective To explore effect comparison between high flux hemodialysis and conventional hemodialysis therapy on acute exacerbation chronic obstructive pulmonary diseases (AECOPD) patients with renal insufficiency.Methods Clinical data of 51 AECOPD combined renal insufficiency (BUN≥20 mmol/L,CREA≥400 μmol/L) cases admitted in ouRhospital and Guiyang First People′s Hospital from 2010 to 2015 were retrospectively analyzed.And were randomly divided into high flux hemodialysis (HFHD) group with 25 cases and conventional hemodialysis (CHD) group with 26 cases according to different dialysis method and dialysis,and the two groups before treatment all used the same internal medicine comprehensive treatment.Blood leukocyte count,neutrophil percentage,blood gas index[pH、SaO2、p(O2)],c-reactive protein (CRP) and interleukin-1 (IL-1),interleukin-6 (IL-6) and renal function (BUN and CREA) before and afteRtreatment were detected,and the difference of the above indexes before and afteRtreatment in both groups were compared.Results Leukocyte count,neutrophil percentage,CRP,IL-1,IL-6,BUN and CREA in two groups afteRtreatment were significantly decreased than treatment before (P<0.01),but HPHD group decreased more than CHD group (P<0.05).Blood and gas index in HPHD group and CHD group afteRtreatment fell,but there was no significant difference (P<0.05).Conclusion High flux hemodialysis (HPHD) has superioRcurative effect in the treatment of AECOPD and in removing inflammatory mediators,infection control,improving renal function,so it is worthy of clinical application.

Objective To explore effect comparison between high flux hemodialysis and conventional hemodialysis therapy on acute exacerbation chronic obstructive pulmonary diseases (AECOPD) patients with renal insufficiency.Methods Clinical data of 51 AECOPD combined renal insufficiency (BUN≥20 mmol/L,CREA≥400 μmol/L) cases admitted in ouRhospital and Guiyang First People′s Hospital from 2010 to 2015 were retrospectively analyzed.And were randomly divided into high flux hemodialysis (HFHD) group with 25 cases and conventional hemodialysis (CHD) group with 26 cases according to different dialysis method and dialysis,and the two groups before treatment all used the same internal medicine comprehensive treatment.Blood leukocyte count,neutrophil percentage,blood gas index[pH、SaO2、p(O2)],c-reactive protein (CRP) and interleukin-1 (IL-1),interleukin-6 (IL-6) and renal function (BUN and CREA) before and afteRtreatment were detected,and the difference of the above indexes before and afteRtreatment in both groups were compared.Results Leukocyte count,neutrophil percentage,CRP,IL-1,IL-6,BUN and CREA in two groups afteRtreatment were significantly decreased than treatment before (P<0.01),but HPHD group decreased more than CHD group (P<0.05).Blood and gas index in HPHD group and CHD group afteRtreatment fell,but there was no significant difference (P<0.05).Conclusion High flux hemodialysis (HPHD) has superioRcurative effect in the treatment of AECOPD and in removing inflammatory mediators,infection control,improving renal function,so it is worthy of clinical application.

Objective: To investigate the protective effect of glucagon-like peptid-1 (GLP-1) against cardiac microvascular endothelial cell (CMECs) injured by high glucose. Methods: CMECs were isolated and cultured. Superoxide assay kit and dihydroethidine (DHE) staining were used to assess oxidative stress. TUNEL staining and caspase 3 expression were used to assess the apoptosis of CMECs. H89 was used to inhibit cAMP/PKA pathway; fasudil was used to inhibit Rho/ROCK pathway. The protein expressions of Rho, ROCK were examined by Western blot analysis. Results: High glucose increased the production of ROS, the activity of NADPH, the apoptosis rate and the expression level of Rho/ROCK in CMECs, while GLP-1 decreased high glucose-induced ROS production, the NADPH activity and the apoptosis rate and the expression level of Rho/ROCK in CMECs, the difference were statistically significant (. P<0.05). Conclusions: GLP-1 could protect the cardiac microvessels against oxidative stress and apoptosis. The protective effects of GLP-1 are dependent on downstream inhibition of Rho through a cAMP/PKA-dependent manner, resulting in a subsequent decrease in the expression of NADPH oxidase.

Objective:To investigate the effect of enhanced recovery after surgery (ERAS) in percutaneous pedicle screw internal fixation treating thoracolumbar fracture patients.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with thoracolumbar fracture treated by percutaneous pedicle screw internal fixation at Second Hospital of Soochow University from October 2018 to April 2019. There were 42 males and 20 females, aged 27-59 years (mean, 43.9 years). Fracture site included T 11 in 4 patients, T 12 in 28, L 1 in 23 and L 2 in 7, and AO type contained type A1 in 40 patients, type A2 in 3, and type A3 in 19. Thirty-one patients were treated with ERAS nursing mode (ERAS group), and other 31 patients with routine nursing mode (control group). The postoperative recovery time of intestinal function, first time of expelling flatus and dejection time, hospitalization time, preoperative and postoperative pain visual analogue scale (VAS), Kolcaba comfort scale (GCQ), Oswestry disability index (ODI), incidence of abdominal distension, incidence of urinary tract infection, first wake up dizziness, urinary retention, and wound healing were compared between the two groups. Results:Period of follow-up for all patients was 3-6 months (mean, 4.5 months). Postoperative recovery time of intestinal function, first time of expelling flatus and dejection time in ERAS group were (7.2±2.0)hours, (10.7±3.7)hours and (26.7±6.4)hours, respectively, which were significantly decreased compared to control group [(19.2±5.6)hours, (22.5±5.1)hours, (72.5±12.4)hours] ( P<0.05). Hospitalization time was (4.7±1.3)days in ERAS group, shorter than that in control group [(5.9±1.5)days]. There was no significant difference in VAS preoperatively between the two groups ( P>0.05). VAS in ERAS group was (3.6±1.5)points, (2.8±0.8)points, (1.7±0.6)points at postoperative 1, 3 and 7 days, lower than that in control group [(4.6±1.3)points, (4.0±1.3)points, (2.7±0.9)points] ( P<0.05). GCQ score in ERAS group was (72.0±6.5)points, (75.0±11.1)points, (88.4±5.1)points and (89.3±4.5)points at 2 hours before operation and 2 hours, 1 days and 3 days after operation, which were higher than that in control groups [(54.0±7.2)points, (59.5±6.3)points, (62.7±5.9)points, (76.0±5.7)points] ( P<0.05). ODI in ERAS group was 37.3±5.8, 28.9±6.3 and 23.1±2.7 at 3 days, 1 month and 3 months after operation, which was markedly decreased compared to control group (44.9±7.9, 33.9±8.7, 30.3±5.3) ( P<0.05). Moreover, the incidence of abdominal distension, urinary tract infection and first wake up dizziness in ERAS group was 7%, 5%, 3%, respectively, reduced from that in control group (26%, 35%, 16%) ( P<0.05). No significant difference was observed in urinary retention wound healing of the two groups, but there was no difference in wound healing ( P>0.05). Conclusion:For thoracolumbar fracture patients treated with percutaneous pedicle screw internal fixation, ERAS has advantages over traditional nursing in attenuating pain, shortening hospitalization time, reducing postoperative abdominal distension and urinary tract infection, and accelerating functional recovery.

Objective:To investigate the application effect of Precede-Proceed model nursing in postoperative anti-osteoporosis treatment of patients with osteoporotic thoracolumbar fracture (OTLF).Methods:A retrospective cohort study was conducted to analyze the clinical data of 168 patients with OTLF admitted to the Second Affiliated Hospital of Soochow University from September 2021 to June 2022, including 32 males and 136 females, aged 56-81 years [(72.0±6.6)years]. The fractured segments were T 1-T 10 in 29 patients, T 11-L 2 in 114 and L 3-L 5 in 25, all of whom were treated with percutaneous kyphoplasty (PKP). The 86 patients admitted from September 2021 to January 2022 were treated with conventional care (conventional nursing group) and the 82 patients admitted from February to June 2022 with Precede-Proceed model care (Precede-Proceed model nursing group). The compliance rates of anti-osteoporosis treatment at 1 and 6 months postoperatively and at the last follow-up were compared between the two groups, mainly including standardized medication, balanced diet, exercise and regular return visit. Chinese Osteoporosis Quality of Life (COQOL) questionnaire, including pain degree, physical function, social interaction ability, psychological and mental function, and total score were assessed before, at 6 months after surgery and at the last follow-up. Bone mineral density was measured preoperatively and at the last follow-up. Recurrence rate was recorded at the last follow-up. Results:All the patients were followed up for 12-16 months [(13.2±1.0)months]. There were 3 patients in the conventional nursing group and 2 in the Precede-Proceed model nursing group who were lost to follow-up. The compliance rates of standardized medication and regular return visit at 1 month after surgery were 97.5% (78/80) and 98.8% (79/80) in the Precede-Proceed model nursing group, which had no significant difference compared with 90.3% (75/83) and 96.4% (80/83) in the conventional nursing group ( P>0.05). The compliance rates of balanced diet and exercise at 1 month after surgery were 92.5% (74/80) and 91.3% (73/80) in the Precede-Proceed model nursing group, which were higher than those in the conventional nursing group [78.3% (65/83) and 73.5% (61/83)] ( P<0.05 or 0.01). The compliance rates of standardized medication, balanced diet, exercise and regular return visit at 6 months after surgery were 86.3% (69/80), 83.8% (67/80), 82.5% (66/80) and 90% (72/80) in the Precede-Proceed model nursing group, which were higher than those in the conventional nursing group [57.8% (48/83), 60.2% (50/83), 38.6% (32/83) and 37.3% (31/83)] ( P<0.01). At the last follow-up, the compliance rates of all the aspects in the Precede-Proceed model nursing group were 80% (64/80), 75% (60/80), 70% (56/80) and 82.5% (66/80), which were all higher than those of the conventional nursing group [36.1% (30/83), 54.2% (45/83), 26.5% (22/83) and 27.7% (23/83)] ( P<0.01). There were no statistical differences in COQOL scores including pain degree, physical function, social interaction ability, psychological and mental function and total scores between the two groups before surgery ( P>0.05). The pain degree, social interaction ability, psychological and mental function and total scores of COQOL in the Precede-Proceed model nursing group were lower than those in conventional nursing group at 6 months after surgery and at the last follow-up ( P<0.05 or 0.01). There was no statistical difference in the physical function of COQOL scores at 6 months after surgery ( P>0.05). The physical function of COQOL scores in the Precede-Proceed model nursing group were significantly lower than that of the conventional nursing group at the last follow-up ( P<0.05). There was no statistical difference in preoperative bone mineral density between the two groups ( P>0.05). Bone mineral density in the Precede-Proceed model nursing group was (-2.7±0.9)SD at the last follow-up, which was higher than that in the conventional nursing group [(-3.1±0.9)SD] ( P<0.05). At the last follow-up, bone mineral density of the Precede-Proceed model nursing group was significantly improved compared with that before surgery ( P<0.01), while there was no significant difference in the conventional nursing group ( P>0.05). The incidence of refracture in the Precede-Proceed model nursing group was 3.8% (3/80), which was lower than that in conventional nursing group [13.3% (11/83)] ( P<0.05). Conclusion:Compared with the conventional nursing mode, the Precede-Proceed model nursing can significantly improve the compliance rate of OTLF patients with postoperative anti osteoporosis treatment, improve their quality of life and bone quality, and reduce the incidence of refracture.

Objective:To evaluate the role of NOD-like receptor 3 (NLRP3) inflammasome activation-mediated macrophage polarization in myocardial injury after ischemic stroke in diabetic mice.Methods:Wild-type C57BL/6J mice and NLRP3 -/- mice, aged 4-6 weeks, were fed a high fat diet combined with streptozotocin administration to develop the diabetic model. Twenty-four diabetic wild type C57BL/6J mice and 23 diabetic NLRP3 -/- mice were divided into wild type sham operation group (WT D-SHAM group, n=9) , wild type ischemic stroke group (WT D-MCAO group, n=15) , NLRP3 -/- sham operation group (NLRP3 -/-D-SHAM group, n=9) and NLRP3 -/- ischemic stroke group (NLRP3 -/-D-MCAO group, n=14). The ischemic stroke model was developed by middle cerebral artery occlusion in the animals anesthetized with isoflurane. Echocardiography and electrocardiography were carried out at 3, 7, 14 and 28 days after developing the model. Mice were sacrificed under deep anesthesia, and myocardial tissues were taken at 28 days after surgery for determination of the expression of macrophage marker F4/80 and M2 type macrophage marker CD206 mRNA (by real-time fluorescence quantitative polymerase chain reaction). Results:Compared with WT D-SHAM group, the cardiac output, mass of left ventricle and corrected mass of left ventricle were significantly decreased at 28 days after surgery, and QT interval and QTc interval were prolonged at 14 and 28 days after developing the model in WT D-MCAO group ( P<0.05). Compared with NLRP3 -/-D-SHAM group, the cardiac output, mass of left ventricle and corrected mass of left ventricle were significantly decreased, and QT interval and QTc interval were prolonged at 3 days after surgery in NLRP3 -/-D-MCAO group ( P<0.05). There was no significant difference in CD206 and F4/80 mRNA expression between WT D-SHAM group and WT D-MCAO group and between NLRP3 -/-D-SHAM group and NLRP3 -/-D-MCAO group ( P>0.05). Compared with WT D-MCAO group, the QT interval and QTC interval were significantly shortened at 14 and 28 days after developing the model, and the expression of F4/80 mRNA was down-regulated and the expression of CD206 mRNA was up-regulated at 28 days after developing the model in NLRP3 -/-D-MCAO group ( P<0.05). Conclusions:NLRP3 inflammasome activation-mediated polarization of macrophages to M2 phenotype is involved in myocardial injury after ischemic stroke in diabetic mice.

Objective:To compare the clinical efficacy of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture.Methods:A retrospective cohort study was performed to analyze the clinical data of 71 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from May 2018 to May 2020. There were 52 males and 19 females, with age range of 22-54 years［(41.0±7.8)years］. Of all, 33 patients were treated with robot-assisted percutaneous screw implantation (Group A) and 38 patients were treated with free-hand open screw implantation by Wiltse approach (Group B). Following parameters were measured, including frequency of radiation exposure, operation time, intraoperative blood loss, length of hospital stay, incidence of complications, rate of fracture healing at 3 months and 6 months postoperatively, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at 3 days, 3 months, 6 months postoperatively and at the last follow-up, anterior vertebral body height ratio and sagittal Cobb angle preoperatively, at 3 days postoperatively and at the last follow-up, and rate of screw implantation of grade A and B and rate of facet joint violation at 3 days postoperatively.Results:All patients were followed up for 10-24 months［(15.2±4.4)months］. Frequency of radiation exposure and operation time showed no statistical differences between the two groups (both P>0.05). Intraoperative blood loss was 100(100, 135)ml in Group A, less than 160(120, 200)ml in Group B ( P<0.01). Length of hospital stay was 8(7, 11) days in Group A, shorter than 12(10, 16)days in Group B ( P<0.01). There were no complications such as infection, spinal nerve injury or cerebrospinal fluid leakage in both group. There were no significant differences between the two groups in the rate of fracture healing at 3 and 6 months postoperatively (all P>0.05). VAS and ODI in Group A was 3(2, 4)points and 21(18, 23)points at 3 days postoperatively, lower than 4 (3, 5)points and 27(20, 32)points in Group B ( P<0.05 or 0.01), and the two groups showed no significant differences in VAS and ODI at other time points (all P>0.05). There were no significant difference in the anterior vertebral body height ratio or sagittal Cobb angle between the two groups at 3 days postoperatively and at the last follow-up (all P>0.05). Rate of screw implantation of grade A and B was 96.5% (191/198) in Group A, higher than 90.4% (206/228) in Group B ( P<0.05). Rate of facet joint violation was 4.0%(8/198) in Group A, lower than 11.8% (27/228) in Group B ( P<0.01). Conclusion:For thoracolumbar fracture, robot-assisted percutaneous screw implantation is superior to free-hand open screw implantation by Wiltse approach in terms of less bleeding, shorter hospitalization, earlier pain alleviation, higher accuracy of screw implantation and lower risk of facet joint violation.