Objective To observe the effect of Niaoduqing granules on chronic renal failure in patients with blood lipid and blood homocysteine.Methods Patients with chronic renal failure were divided into observation group and control group by number table method,two groups of patients were both given low salt,low fat and high quality low protein diet,controlling blood pressure and blood sugar,correcting anemia,correcting calcium and phosphorus meta-bolic disorders,correcting of acidosis,while patients with combined infection were given positive anti infection treat-ment.Observation group was treated with Niaoduqing granules on that basis.The changes of triglyceride(TG),total cholesterol( HDL-C) ,total cholesterol( CHO) ,low-density lipoprotein( LDL-C) ,and plasma homocysteine( Hcy) were observed before and after treatment in the two groups.Results After treatment,CHO,TG,HDL-C,LDL-C, Hcy in the control group were respectively (4.83 ±0.22)mmol/L,(2.21 ±0.30)mmol/L,(0.69 ±0.11)mmol/L, (4.30 ±0.32)mmol/L,(24.35 ±7.05)μmol/L,that threre was no significant changes before and after treatment.In the observation group,TG,LDL-C,Hcy were (1.38 ±0.18)mmol/L,(3.29 ±0.13)mmol/L,(14.54 ±3.56)umol/L respectively after treatment,and which were significantly lower than that before treatment ( t=1.45,2.13,4.28,all P<0.05).HDL-C (1.42 ±0.31)mmol/L,were significantly increased after treatment as compared with that before treatment (t=3.88,P<0.05).The difference of Hcy,TG,LDL-C,HDL-C and CHO after treatment was statisti-cally significantin between the two groups (t=1.34,2.08,1.10,3.88,all P<0.05).Conclusion Niaoduqing gran-ules can improve lipid metabolism disorders in patients with chronic renal failure,and can reduce the serum homocys-teine.

Objective To evaluate the clinical prevention and cure efficiency of panax notoginosides(PNS) in patients with chronic renal failure.Methods 60 patients with chronic renal failure were selected and randomly divided into the control group and the observation group,with 30 cases in each group by random number table.The patients in the control group underwent regular maintenance hemodialysis(MHD),while the patients in the observa-tion group were given PNS glucose injection on the base of the control group for two months treatment.Comparison was made between the two groups in the aspect of liver filament four items,renal function,blood lipids and the levels of TGF-β1 ,TIMP-1 expression for renal fibrosis.Results After two months treatment,the liver filament four items (t=3.94-5.62,all P<0.05),renal function (t=4.15,4.29,all P<0.05),blood lipids (t=3.83 -5.47,all P<0.05)and the level of TGF-β1,TIMP-1 were all significantly decreased in the observation group,while HA, blood lipids and the level of TGF-β1(t=5.19,P<0.01),TIMP-1(t=4.16,P<0.05)were also decreased in the control group.All the indexes of the observation group were much significant than those of the control group.Total effective rate of the observation group was 83.33%,which was significantly higher than 66.67% of the control group (χ2 =5.16,P<0.05).There was no adverse reaction in the observation group.Conclusion PNS could improve renal fibrosis by lowering the level of TGF-β1 and TIMP-1 ,and could be used as conventional auxiliary drug for patients with chronic renal failure.

Objective The study aimed to discuss the scientific property and feasibility of back measurement of neonates' temperature. Methods Three measurement methods(axillary,under the jaw and the back) were adopted to measure the temperature for 100 neonates for 7,10 and 30 minutes.The tempera-ture measured by rectum for 3 minutes was set as the control. Results . Temperature by back measure-merit was not different from that measured by other methods in the same time period,P ＞ 0.05.Temperature by back measurement for 7,10 and 30 minutes was not different from that measured by rectum for 3 min-utes,P ＞ 0.05. Temperature by back measurement for 7,10 minutes for neonates using radiation rescue plat-form and warm case was not different from that measured by rectum,P ＞ 0.05.Temperature measured by ax-illary and under the jaw for 30 minutes was different from that measued by rectum, P ＜ 0.05.While temper-ature by back measurement for 30 minutes was not different from that measured by rectum,P ＞ 0.05.Conclusions Back measurement of temperature as well as by axillary and the jaw could be used in pedi-atric department.h could accurately obtain the real temperature of neonates and was not influenced by radi-ation rescue platform and warm case.Besides,it reduced the workload of nurses and was safe,effective,simple,practical and worth applying widely in clinic.

OBJECTIVE To assess the ultrasonographic features and clinical significance of the complications of the thyroglossal cysts. METHODS We retrospectively reviewed the ultrasonographic findings in 41 cases with complications of the thyroglossal cyst, which was confirmed surgically and pathologically. 43 cases with simple thyroglossal cyst consisted of the control group. The location, size, internal echo, internal septa, wall thickness, posterior acoustic feature, boundary, vascularity, and fistulas of the lesion were analyzed and compared with the control group. RESULTS Most of the inflammatory thyroglossal cyst showed thickening walls, indistinct boundaries, posterior echo enhancement, and peripheral vascularity on ultrasound images. There were significant differences of the thickness of the cyst wall, indistinct boundary, and peripheral vascularity between the two groups. CONCLUSION The characteristic findings of thyroglossal cyst with inflammation are thickened wall, indistinct boundary, and peripheral vascularities. Ultrasonography can be useful tool in determination of the appropriate time of the operation to reduce the recurrence rate.

Objective To observe value of high frequency ultrasound for inspection of T7-8 paravertebral space and adjacent structures.Methods Color Doppler ultrasonic diagnostic apparatus with linear array transducer (frequency 3-12 MHz) were used.Taking shoulder blade,ribs,thoracic spine and transverse process as anatomical marks,T7-8 paravertebral spaces of 30 normal adult (a total of 60 side) were examined.Ultrasonographic features of T7-8 paravertebral space and the adjacent structures were observed.Results T7-8 thoracic paravertebral showed as similar triangular shape with ultrasonography,interior solid homogeneously hypoechoic was noticed.Adjacent muscles of T7-8 paravertebral space included the trapezius,latissimus dorsi,spinalis,semispinalis,multifidus,rotatores and intercostal muscles.Color Doppler or power Doppler flow imaging could demonstrate posterior intercostal artery in the paravertebral space.Conclusion High frequency ultrasound can clearly show T7-8 paravertebral space and adjacent structures,thus providing ultrasonic references for clinical diagnosis and treatment of lesions of thoracic space and adjacent structures.

Objective:To extract the differentially expressed key genes of primary biliary cholangitis (PBC) using bioinformatics methods, so as to provide information for further study into the mechanism.Methods:The GSE119600 dataset was downloaded from the GEO database to obtain differentially expressed genes. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed for differentially expressed genes. Protein-protein interaction (PPI) network reconstruction, Cytoscape software visualization, and core gene screening were performed. The area under the receiver operating characteristic curve (ROC AUC) was used to assess the diagnostic effectiveness of genes and plot the pROC software package. The x-Cell software was used to calculate the enrichment score of 34 immune cells in each sample. Finally, four key genes (PSMA4, PSMA1, PSMB1, and PSMA3) were selected. Blood samples were analyzed using the qPCR method.Results::A total of 373 immune-related differentially expressed genes were identified. Eight genes (PSMC6, PSMB2, PSMB1, PSMA3, PSMA4, PSMA1, PSMD7, and PSMB5) were screened from the 178 nodes and 596 edges as hub genes of the PPI network, which were significantly related to amino acid metabolism, hematopoietic stem cell differentiation, cell cycle, and immune processes. PSMA4, PSMA1, PSMB1, and PSMA3 were defined as immunological biomarkers for PBC with an AUC value of the ROC curve > 0.7. Immunoinfiltrating cell analysis showed that the proportion of eosinophils was significantly higher in PBC patients compared to the control group, whereas the proportion of CD4+ memory T cells, plasma cells, Th2 cells, and cDC cells was significantly lower in PBC patients than the control group. Plasma cells were associated with all four immunological biomarkers. Seven PBC patients and seven healthy subjects were selected for peripheral blood qPCR validation, which demonstrates that PSMB1, PSMA3, PSMA1, and PSMA4 levels were significantly lower in PBC patients than healthy subjects, with a statistically significant difference.Conclusion::Bioinformatics screened eight key genes, of which four were key immunological markers and may serve as a basis for clinical diagnosis and mechanism exploration.

Objective:To analyze the effectiveness and interobserver agreement of the Parer five-tier, the National Institute of Child Health and Human Development (NICHD) three-tier, and the International Federation of Gynecology and Obstetrics (FIGO) three-tier electronic fetal monitoring (EFM) systems in identification of neonatal acidosis during labor.Methods:This retrospective study was conducted on full-term singleton cephalic deliveries with neonatal acidosis (umbilical artery blood gas pH≤7.1) and normal newborns (umbilical artery blood gas pH≥7.2) in the Nanjing Drum Tower Hospital, Nanjing University Medical School from January to December 2020. EFM tracings during the last 30-60 min before delivery were collected. Four obstetricians independently described the features of randomly sorted and coded EFM tracings. Another obstetrician categorized these tracings using the NICHD three-tier, FIGO three-tier, and Parer five-tier evaluation systems based on the features. All researchers were masked to the clinical characteristics and maternal and neonatal outcomes. The sensitivity and specificity for identifying neonatal acidosis, as well as the interobserver agreement, were analyzed for all three systems. Independent sample t-test, Chi-square (or Fisher's exact test) and Mann-Whitney U tests were used for statistical analysis. Inter-group comparisons of sensitivity and specificity between the three evaluation systems were assessed using McNemar's test. The Kappa statistic was used to analyze interobserver agreement. Results:This study included a total of 3 558 cases. After propensity score matching, there were 44 cases of neonatal acidosis and 78 control cases. There were no significant differences in parity, gestational weeks, modes of delivery, placental abruption, or analgesia rates between the two groups. The rates of instrumental vaginal delivery and neonatal intensive care unit (NICU) admission in the acidosis group were significantly higher than those in the control group [15.8% (7/44) vs. 2.6% (2/78), χ2=8.45, P=0.003; 31.8% (14/44) vs. 12.8% (10/78), χ2=8.45, P=0.004], while the umbilical artery blood pH and mean base excess were lower in the acidosis group than in the control group [7.04±0.07 vs. 7.30±0.05, t=4.98; (－12.40±3.32) vs. (－5.64±1.95) mmol/L, t=13.61; both P<0.001]. (2) Using the NICHD three-tier system, 95.5% (42/44) of the acidosis cases and 89.7% (70/78) of the control cases were classified as having category Ⅱ EFM tracings, indicating potential fetal acid-base imbalance; category Ⅲ EFM tracings were only observed in 4.5% (2/44) of the cases in the acidosis group. With the FIGO three-tier system, 81.8% (36/44) of the acidosis cases were categorized as having "pathological" tracings, and with the Parer five-tier system, 86.4% (38/44) of the acidosis cases were correctly classified into the "orange or red" risk zones that indicated acid-base imbalance. Among the control cases, there were 28.2% (22/78) with EFM tracings of "normal patterns" categorized by the FIGO three-tier system, and 41.0% (32/78) classified into the "green or blue" risk zones by the Parer five-tier system, which indicated good fetal conditions. None of the acidosis cases were misdiagnosed as being normal by the Parer five-tier system. (3) Compared with the NICHD three-tier system, both the FIGO three-tier and the Parer five-tier systems showed increased diagnostic sensitivity [4.5% (1.2%- 14.5%) vs. 81.8% (66.8%-89.4%) and 86.4% (71.8%-92.4%)], but decreased specificity [100.0% (95.3%- 100.0%) vs. 87.2% (78.0%-92.9%) and 84.6% (75.0%-91.0%)]. There was no statistically significant difference in the sensitivity or specificity between the FIGO three-tier and Parer five-tier systems for identifying neonatal acidosis ( P=0.727 and 0.791). (4) When reading the tracings of control cases, the total agreement rate for the NICHD three-tier system by different observers was as high as 94.2%, while the total agreement rates for the FIGO three-tier and Parer five-tier systems were 69.7% and 67.7%, respectively. In the interpretation of EFHR tracings for acidosis cases, the interobserver agreement for the Parer five-tier system was excellent [Kappa (95% CI): 0.87 (0.79-0.95)], while both the NICHD three-tier and FIGO three-tier systems showed good agreement [Kappa (95% CI): 0.77 (0.66-0.88) and 0.72 (0.60-0.84)]. Conclusions:The Parer five-tier and the FIGO three-tier systems have higher sensitivity in identifying neonatal acidosis than the NICHD three-tier system, and the Parer five-tier system achieves a higher negative predictive value and a greater agreement in the interpretation of pathological EFM patterns.

The diagnosis of food allergy in children is one hotspot attracting people′s attention in recent years.The incidence of it shows an increasing trend which exposes problems in the understanding of children′s food allergy in China, especially in the misdiagnosis and missed diagnosis.To further standardize the diagnosis and treatment of food allergy in children, based on the current domestic, foreign guidelines and relevant research evidence, the guideline recommends 16 clinical hot-button issues in the 4 aspects of diagnosis, treatment, prognosis, and prevention.Finally, a diagnosis flowchart has been formulated.The guideline aims to improve the standard diagnosis and treatment of food allergies in children in China.

Objective:To explore the application value of artificial intelligence (AI) model based on deep learning in breast nodules classification of Breast Imaging Reporting and Data System of ultrasound (BI-RADS-US).Methods:The ultrasound images of 2 426 breast nodules from 1 558 female patients with breast diseases at Beijing Tongren Hospital, Capital Medical University between December 2006 and December 2019 were collected . The image data sets were divided into training (63%), verification (7%), and test (30%) subsets for the construction of AI model. The diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were analyzed by using receiver operating characteristic (ROC) curve. The Cohen weighted Kappa statistic was used to compare the consistency of BI-RADS-US classification among 5 ultrasound doctors' diagnosis with or without AI model assistance. And the changes of BI-RADS-US classification were analyzed before and after each doctor adopted AI model assistance.Results:The differences in diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were statistically significant (all P > 0.05). The consistency among 5 ultrasound doctors was improved due to AI model assistance and Kappa value was increased from 0.433 (category 3), 0.600 (category 4a), 0.614 (category 4b), 0.570 (category 4c) and 0.495 (category 5) to 0.812, 0.704, 0.823, 0.690 and 0.509 (all P < 0.05), respectively. The upgrade and downgrade of BI-RADS-US classification occurred in 5 doctors after the classification of AI model assistance. Downgrade from category 4 to 3 in benign nodules of 56.6% (47/76) and upgrade from category 4 to 5 in malignant nodules of 69.4% (34/49) were mostly observed. Conclusions:AI-assisted BI-RADS-US classification can effectively improve the consistency of classification among the doctors without reducing the diagnostic efficiency. AI model shows clinical values in reducing unnecessary biopsy of partial benign lesions and increasing diagnostic accuracy of partial malignant lesions through the adjustment of breast nodule classification.

Objective: To investigate the serotype distribution and antimicrobial susceptibility pattern of Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae) and Moraxella catarrhalis (M. catarrhalis) isolates collected from nasopharyngeal swabs from Uygur children in Kashi. Methods: Nasopharyngeal swabs were collected from inpatient Uygur children aged from 1 month to 5 years with respiratory infections from the pediatric department, the First People's Hospital of Kashi, Xinjiang Uygur Autonomous Region. Antimicrobial susceptibilities of the isolates were determined with E-test and KB disk diffusion methods. The production of β-lactamase was detected for H. influenzae and M. catarrhalisisolates using nitrocefin disc method. Quellung test and latex agglutination test were adopted to identify serotypes of S. pneumoniae and H. influenzae isolates. Results: Forty-seven S. pneumoniae, 13 H. influenzae and 16 M. catarrhalis isolates were detected. All of the 47 S. pneumoniae isolates were sensitive to parenteral penicillin, amoxicillin-clavulanic acid, vancomycin and levofloxacin; the susceptibility rates to cefotaxime, imipenem and chloramphenicol were 94% (44/47), 89% (42/47), and 98% (46/47). The resistance rate to erythromycin was 74% (35/47). The most common serotype of S. pneumoniae was serotype 19A (10 strains, 21%). The coverage rate of 13-valent conjugate vaccine (PCV13) was 70% (33/47). None of the 13 H. influenzae isolates could be typed. They were highly susceptible to tested β-lactams antibiotics, except ampicillin. Only one H. influenzae isolate could produce β-lactamase, and two isolates were identified as β-lactamase-negative-ampicillin-resistant ones. The sixteen M. catarrhalis isolates were all positive in β-lactamase detection, but sensitive to amoxicillin-clavulanic acid, cephalosporins and meropenem. Conclusions In Kashi, Xinjiang Uygur Autonmous Region, S. pneumoniae isolates from Uygur children were highly sensitive to parenteral penicillin and other β-lactams antibiotics. H. influenzae isolates from Uygur children were highly susceptible to amoxicillin-clavulanic acid, cephalosporins and ciprofloxacin. All M. catarrhalis isolates from Uygur children could produce β-lactamase, but were sensitive to the enzyme inhibitors and cephalosporins.