Objective To compare the accuracy of bedside lung ultrasound in emergency(BLUE)and combined cardiac-lung and additional ultrasound(CLAUS)for diagnosing the causes of acute dyspnea.Methods Totally 1 016 patients with acute dyspnea were retrospectively enrolled and divided into cardiogenic pulmonary edema group(n=268),pneumonia group(n=574),pneumothorax group(n=33),pulmonary embolism group(n=67)and CAD(chronic obstructive pulmonary disease/asthma/diaphragmatic dysfunction)group(n=74)according to the causes of acute dyspnea.The findings of CLAUS protocol were compared among groups,and the accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea were also compared.Results CLAUS showed that B-B and B-C were the most common modes in cardiogenic pulmonary edema group,while A-B/A-C/B-A/B-B/B-C/C-C modes were common in pneumonia group,and A-A mode was the most common in pneumothorax group,pulmonary embolism group and CAD group.Significant differences of the manifestations of pulmonary ultrasound,pleural feature of anterior chest wall,left/right cardiac insufficiency and abnormal inferior vena cava diameter were found among groups(all P＜0.05).The accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea was 86.91%(883/1 016)and 94.49%(960/1 016),respectively,the latter was higher than the former(χ2=34.587,P＜0.05).Conclusion CLAUS protocol could be used to effectively diagnose the causes of acute dyspnea,with higher accuracy than BLUE protocol.

OBJECTIVE To investigate the monitoring of tacrolimus blood concentration in patients with nephrotic syndrome （NS），and to establish a prediction model for tacrolimus blood concentration. METHODS Data from 509 concentration monitoring sessions of 166 NS patients using tacrolimus were collected from January 1， 2020 to August 31， 2023 in Zhongshan Hospital Affiliated to Xiamen University. The relationship of efficacy and adverse drug reaction（ADR） with blood concentration was analyzed. A multilayer perceptron （MLP） prediction model was established by using the blood concentration monitoring data of 302 times from 109 NS patients with genetic information， and then verified. RESULTS In terms of efficacy， the median blood concentration of tacrolimus in the non-remission group was 2.20 ng/mL， which was significantly lower than that in the partial remission group （4.00 ng/mL， P＜0.001） and the complete remission group （3.60 ng/mL， P＝0.002）. In terms of ADR， the median blood concentration of tacrolimus in the ADR group was 5.01 ng/mL， which was significantly higher than that in the non-ADR group （3.37 ng/mL） （P＝0.001）. According to the subgroup analysis of the receiver operating characteristic curve， when the blood concentration of tacrolimus was ≥6.65 ng/mL， patients were more likely to develop elevated blood creatinine [area under the curve （AUC） was 0.764， P＜0.001）； when the blood concentration of tacrolimus was ≥6.55 ng/mL， patients were more likely to develop blood glucose （AUC＝0.615， P＝ 0.005）. The established MLP prediction model has a loss function of 0.9， with an average absolute error of 0.279 5 ng/mL between the predicted and measured values. The determination coefficient of the validation scatter plot was 0.984， indicating an excellent predictive performance of the model. CONCLUSION Tacrolimus blood concentration has an impact on both efficacy and ADR in NS patients. The use of the MLP model for predicting blood concentration exhibits high accuracy with minimal error between predicted and measured values. The model can be used as an important tool in clinical individualized medication regimens.

BACKGROUND:Satisfactory clinical results have been achieved in the treatment of Sanders Ⅲ calcaneal fractures by percutaneous compression fixation with three-dimensional frame screws.However,whether the stability of minimally invasive plate internal fixation can be achieved in terms of biomechanics,and the advantages and disadvantages after comparison are still unknown. OBJECTIVE:To investigate the fixation effect of different internal fixation devices on Sanders Ⅲ calcaneal fractures by finite element analysis. METHODS:A finite element model of Sanders Ⅲ calcaneal fracture was made based on CT data of a 26-year-old healthy male volunteer.The calcaneal fracture models were fixed by minimally invasive three-dimensional frame screws and minimally invasive Y-plate.The longitudinal loads of 350 and 700 N were applied respectively.The displacement and stress distribution of the two models were analyzed,and the stability of each model was compared. RESULTS AND CONCLUSION:(1)The peak stress of bone block and implant in the minimally invasive three-dimensional frame screw model was significantly lower than that in the minimally invasive minimally invasive plate model.The average stress of bone block and implant in the three-dimensional frame screw model was also significantly lower than that in the minimally invasive plate model.(2)The maximum displacement of the two models was located at the medial side of the articular surface of the posterior talus,and the maximum displacement of the three-dimensional frame screw model was smaller than that of the minimally invasive plate model.(3)The longitudinal displacement between the anterior fragment and the medial fragment of the minimally invasive plate model was smaller,and the transverse and vertical displacement between the medial fragment and the middle fragment of the three-dimensional group screw model was smaller.(4)It is concluded that both of the two internal fixation models can provide satisfactory fixation effect.The three-dimensional frame screw model can provide better transverse and vertical stability with more uniform stress distribution and smaller comprehensive displacement of bone fragments,while the minimally invasive plate has more advantages in maintaining longitudinal stability.

Objective:To explore the effect of Manchester pain management model (MPMM) combined with empowerment education nursing intervention on pain and recovery after cesarean section, and to provide reference for promoting recovery after cesarean section.Methods:A quasi-experimental study was conducted. A total of 120 pregnant women who underwent cesarean section in Shanxi Maternal and Child Health Hospital from September 2021 to June 2022 were selected by convenient sampling method and divided into observation group and control group according to the random number table method, with 60 cases in each group. The observation group received nursing intervention based on MPMM combined with empowerment education, while the control group received routine nursing. The degree of pain, postoperative recovery and nursing satisfaction were compared between the two groups.Results:After the intervention, the pain scores of the observation group were (5.13 ± 1.14), (4.17 ± 0.97), (3.56 ± 0.75) and (3.04 ± 0.79) points in the resting state 8, 12, 24 and 48 h after the operation, respectively, which were lower than (6.02 ± 0.81), (5.05 ± 1.08), (4.48 ± 0.82), (3.50 ± 0.95) points of the control group, the differences were statistically significant ( t values were 2.88 to 6.41, all P < 0.05). The pain scores of the observation group at 8, 12, 24 and 48 hours after operation were (6.98 ± 0.72), (6.44 ± 0.76), (5.48 ± 0.91) and (4.50 ± 0.89) points, respectively, which were lower than (7.62 ± 0.69), (7.47 ± 0.94), (6.95 ± 1.23), (6.18 ± 0.93) points of the control group, the differences were statistically significant ( t values were 4.84 to 10.12, all P<0.05). The time of getting out of bed for the first time in the observation group was (24.70 ± 2.53) h, which was lower than (26.32 ± 3.37) h in the control group, and the difference was statistically significant ( t=2.97, P<0.05). The success rate of first breastfeeding in the observation group was 76.7% (46/60), which was higher than 58.3% (35/60) in the control group, and the difference was statistically significant ( χ2=4.60, P<0.05). The overall nursing satisfaction score of the observation group was (8.25 ± 1.39) points, which was higher than (7.73 ± 1.04) points of the control group, and the difference was statistically significant ( t=-2.31, P<0.05). Conclusions:The nursing intervention based on Manchester pain management model combined with empowerment education can effectively reduce the pain after cesarean section, promote postpartum recovery and improve nursing satisfaction, which is worthy of clinical promotion.

Objective:To analyze the cardio-pulmonary ultrasound features of cardiogenic pulmonary edema (CPE) and pneumonia in adults with acute dyspnea, and to construct a differential diagnosis model.Methods:Seven hundred and forty-three patients with sudden acute dyspnea admitted to Hebei General Hospital from November 2018 to May 2022 were retropectively included. Ultrasonographer A performed lung ultrasound with 12 zone method, and interpreted and recorded the ultrasonic signs (including A-lines area, B-lines area, consolidation area and pleural effusion area) together with ultrasonographer B. According to the ultrasonic characteristics of the whole lung, it was divided into A-profile and B-profile. According to the continuity and symmetry of the distribution of B-lines in bilateral lung fields, it could be divided into bilateral lung continuous and discontinuous B-profile, bilateral lung symmetric and asymmetric B-profile. Left ventricular ejection fraction (LVEF), left ventricular filling pressure (E/e′), right ventricular dilatation, tricuspid annular systolic displacement (TAPSE) and inferior vena cava diameter (IVCD) were evaluated by echocardiography, and all the indexes were transformed into binary variables. According to the final clinical diagnosis and treatment results, the disease was divided into CPE group and pneumonia group. Binary Logistic regression model was used to screen independent influencing factors, and partial regression coefficient β value was used as a weight to assign a score, and a differential diagnosis model was established based on the total score. The predictive value of the model was evaluated by the receiver operating characteristic curve (ROC) and area under curve (AUC). After the model was built, 30 patients with CPE or pneumonia were independently collected by ultrasonographer C as external validation data, which were included in the model to draw ROC curve and evaluate the differential diagnosis efficiency of the model. The consistencies between ultrasonographer A and B, A and C in observing lung ultrasound were explored.Results:A total of 743 patients from 43 clinical departments were included, including 246 cases in CPE group and 497 cases in pneumonia group. Multivariate logistic regression analysis showed that bilateral lung continuous B-profile, bilateral lung symmetric B-profile, ≥1 pleural effusion area, LVEF<50%, E/e′>14 were the risk factors for CPE (all OR>1, P<0.05), and ≥1 consolidation area and ≥1 pleural sliding disappearance area were the protective factors for CPE (all OR>1, P<0.05). The sensitivity, specificity and AUC of combined cardio-pulmonary ultrasound index β value weight score in the differential diagnosis of CPE and pneumonia were 0.939, 0.956 and 0.986, respectively. The AUC of external validation data was 0.904. Ultrasonographer A and B, A and C had good consistency in the interpretation of lung ultrasound signs ( P<0.05). Conclusions:The differential diagnosis model based on combined cardio-pulmonary ultrasound indexes has high differential diagnosis efficiency for CPE and pneumonia, and can be used in bedside cardio-pulmonary ultrasound practice.

In this study,a functionalized covalent-organic framework(COF)was first synthesized using porphyrin as the fabrication unit and showed an edge-curled,petal-like and well-ordered structure.The synthesized COF was then introduced to prepare porous organic polymer monolithic materials(POPMs).Two com-posite POPM/COF monolithic materials with rod shapes,referred to as sorbent A and sorbent B,were prepared in stainless steel tubes using different monomers.Sorbents A and B exhibited relatively uniform porous structures and enhanced specific surface areas of 153.14 m2/g and 80.01 m2/g,respectively.The prepared composite monoliths were used as in-tube solid-phase extraction(SPE)sorbents combined with HPLC for the on-line extraction and quantitative analytical systems.Indole alkaloids(from Catharanthus roseus G.Don and Uncaria rhynchophylla(Miq.)Miq.Ex Havil.)contained in mouse plasma were extracted and quantitatively analyzed using the online system.The two composite multifunctional monoliths showed excellent clean-up ability for complex biological matrices,as well as superior selec-tivity for target indole alkaloids.Method validation showed that the RSD values of the repeatability(n=6)were≤3.46％,and the accuracy expressed by the spiked recoveries was in the ranges of 99.38％-100.91％and 96.39％-103.50％for vinca alkaloids and Uncaria alkaloids,respectively.Furthermore,sorbents A and B exhibited strong reusability,with RSD values≤5.32％,which were based on the peak area of the corresponding alkaloids with more than 100 injections.These results indicate that the composite POPM/COF rod-shaped monoliths are promising media as SPE sorbents for extracting trace compounds in complex biological samples.

Indole-3-carbinol(I3C),an important anticancer compound found in broccoli,has attracted considerable attention.The rapid extraction and accurate analysis of I3C in the pharmaceutical industry in broccoli is challenging as I3C is unstable at low pH and high temperature.In this study,a rapid,accurate,and low-cost ultrasound-assisted dispersive-filter extraction(UADFE)technique based on poly(deep eutectic solvent)-graphene oxide(PDES-GO)adsorbent was developed for the isolation and analysis of I3C in broccoli for the first time.PDES-GO with multiple adsorption interactions and a fast mass transfer rate was synthesized to accelerate adsorption and desorption.UADFE was developed by combining dispersive solid-phase extraction(DSPE)and filter solid-phase extraction(FSPE)to realize rapid extraction and separation.Based on the above two strategies,the proposed PDES-GO-UADFE method coupled with high-performance liquid chromatography(HPLC)allowed the rapid(15-16 min),accurate(84.3％-96.4％),and low-cost(adsorbent:3.00 mg)analysis of I3C in broccoli and was superior to solid-phase extraction,DSPE,and FSPE methods.The proposed method showed remarkable linearity(r=0.9998;range:0.0840-48.0 μg/g),low limit of quantification(0.0840 μg/g),and high precision(relative standard deviation≤5.6％).Therefore,the PDES-GO-UADFE-HPLC method shows significant potential in the field of pharmaceutical analysis for the separation and analysis of anti-cancer compounds in complex plant samples.

Objective To investigate the change of the nutritional status of elderly patients in Chinese major hospitals dynamically with nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA) during hospitalization.Methods A prospective,multi-center survey was conducted on over 65 years old patients who were admitted in departments of gastroenterology,respiratory medicine,general surgery,geriatrics,thoracic surgery,neurology,orthopedics and medical oncology of 9 large hospitals in China for 7-30 days between June 2014 and September 2014.On admission and within 24 hours after discharge,the clinical data were recorded,physical indices were measured,and laboratory examination were conducted.NRS 2002 and SGA were used to make an evaluation.The nutritional supports and clinical outcomes were also recorded and then the correlation between nutritional status and clinical outcomes were analyzed.Results A total of 2558 patients above 65 years old were included into the study.Compared with their status on admission,their grip strength,upper arm circumference and crural circumference were reduced significantly at discharge (P＜0.05).The total protein,albumin and hemoglobin levels were significantly lower than those on admission (P＜0.05).The incidence of nutritional risk (NRS 2002 score ≥ 3) and malnutrition (SGA B + C) on admission were lower than those at discharge (51.1％ vs 53.0％,32.6％ vs 35.6％).The hospitalization time and medical expenses were higher in patients with malnutrition on admission than in those with normal nutrition intakes.The nutritional status at discharge was negatively correlated with hospitalization time and medical expenses.61.3％ patients having nutritional risk did not take nutritional support during the hospital stay,while utilization rate of parenteral nutrition was higher than that of enteral nutrition in patients receiving nutritional support (19.6％ vs 11.9％).Conclusion Elderly patients have higher possibilities of facing nutritional risk or malnutrition on admission,these are associated with poor clinical outcomes and their nutritional status will not improve significantly at discharge.Therefore,the screening and evaluation of nutritional status in elderly patients during hospitalization should be conducted and their nutritional intervention should be standardized so as to improve the clinical outcomes.

Objective To investigate the changes of nutritional status of chronic cardiovascular patients during hospitalization by using nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA).Methods A prospective,parallel multicenter study was can-ied out in 3 tertiary A hospitals in Beijing from June 2014 to September 2014.Subjects in the study had been hospitalized for 7-30 days for various types of chronic cardiovascular diseases.Physical indexes and laboratory examination results were recorded within 24 hours after admission and 24 hours before discharge.The nutritional status was evaluated using NRS 2002 and SGA.Results 454 inpatients were enrolled in this study.Prevalence of undernutrition,defined as body mass index＜ 18.5 kg/m2 with poor general condition,was 7.0％ on admission.Prevalence of nutritional risk (NRS 2002 score≥3) was 27.9％.Patients with heart valve disease (34.6％) and arrhythmia (47.5％) had higher prevalence of nutritional risk,which decreased on discharge.At admission,the prevalence of SGA-based moderate and severe undernutrition (grade B+C) was 16.7％.In particular,this prevalence was higher in patients with heart valve disease (30.7％) and arrhythmia (22.5％).At discharge,the proportion of patients (except patients with coronary heart disease) with moderate and severe dystrophy,especially severe dystrophy,decreased significantly.Conclusions Patients with chronic cardiovascular disease were likely to have comorbid nutritional risk at the time of admission,including undernutrition,as defined by body mass index＜ 18.5 kg/m2 plus poor general condition,and SGA-based moderate or severe malnutrition,which was partially improved on discharge.Attention should be paid to nutritional status screening and evaluation on admission.Reasonable nutrition intervention should be done to correct malnutrition and improve clinical outcomes.

Objective To explore the sleep characteristics of submariners during a long-term voyage, so as to provide scientific evidence for ensuring submariners with good sleep during long-term voyages. Methods The sleep status of submariners who participated in a long-term voyage was tested by Self-Rating Scale of Sleep (SRSS) before the voyage, and before and after each voyage section during the voyage. The sleep status variation of submariners who performed different types of tasks, from the beginning to the end of each voyage section and of each resting-on-the-sea section was analyzed respectively. Comparison of sleep scores was performed between submariners and surface ship crew in the second voyage section. Numbers of submariners with sleep problem were compared in each voyage section. Results Generally speaking, submariners' sleep status at the end of voyage section was significantly worse than that at the beginning of voyage section and that before the whole voyage (P<0.001, P<0.01), and the sleep status at the beginning of the third voyage section was significantly worse than that before the whole voyage (P<0.05). Submariners had a steady sleep status when taking a resting-on-the-sea before starting their first voyage section, which was no significant difference from that before the whole voyage (P>0.05). After finishing a voyage section and taking a resting-on-the-sea, submariners' sleep status returned to the level of pre-voyage (P>0.05), and was significantly better than that before the resting-on-the-sea (P<0.05, P<0.01). After finishing two voyage sections and then taking a resting-on-the-sea, the submariners' sleep status showed no obvious variation (P>0.05). Compared with that of surface ship crew who accomplished the same voyage section, submariners had an obviously better sleep status after taking a resting-on-the-sea (P<0.05). Meanwhile, submariners who finished a voyage section showed a significantly worse sleep status than those resting on the sea (P<0.01) and surface ship crew who finished a same voyage section (P<0.05). In each voyage section, submariners with sleep problems who finished resting-on-the-sea were significantly less than those who finished navigation (P<0.001, P<0.05). There was no significant difference in the number of submariners with sleep problems between those who taking non-resting and taking resting-at-dock after finishing the first voyage section (P>0.05), but the latter was significantly more than the former when the second voyage section was finished (P<0.05). During the resting-on-the-sea period, the numbers of submariners with sleep problems in both the second and the third voyage section were significantly more than those in the first voyage section (P<0.05, P<0.01). The numbers of submariners with sleep problems who implemented the third voyage section were significantly more than those who implemented the first and the second voyage section (P<0.01). Conclusions Generally, the sleep quality of submariners is significantly worse after accomplished a voyage section task, and the degree of sleep problems may be accumulated to worse and worse along with the increase of long-term voyage time. Whereas, submariners may have a significantly better sleep status after taking a resting-on-the-sea, implying that resting-on-the-sea is an effective way to ensure submariners a good sleep during a long-term voyage.