Objective To evaluate the model for end-stage liver disease (MELD) and MELD combined with serum natrium level (MELD-Na) in predicting short-term prognosis of liver failure.Methods Clinical data of 322 patients with liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from April 2003 to April 2012 were retrospectively analyzed.MELD and MELD-Na scores were calculated at diagnosis and one week after the diagnosis,and then △MELD and △MELD-Na were determined.Receiver operating characteristics (ROC) curve and Kaplan-Meier survival curve were used to evaluate the value of the above scores in predicting 3-month prognosis.Results The 3-month mortality rates of acute/sub-acute,acute-on-chronic and chronic liver failure were 77.4％ (24/31),41.7％ (50/120) and 56.1％ (96/171),respectively,and the difference was of statistical significance (x2 =14.273,P ＜0.01).For acute/sub-acute liver failure,the areas under ROC curve (AUCs) were 0.699-0.836 for each scoring system in predicting short-term prognosis,and no significant difference was observed (Z =0.507,0.622,0.712,0.727,0.779 and 0.599,P ＞0.05).For acute-on-chronic liver failure,AUCs were 0.889 and 0.897 for △MELD and △MELD-Na in predicting short-term prognosis,which were higher than those of MELD and MELD-Na scores at the baseline (Z =3.110 and 3.500,P ＜ 0.05),but no significant difference was observed between △MELD and △MELD-Na (Z =0.310,P ＞ 0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 3.5 was 87.8％,and the average survival time was 34.05 d.For chronic liver failure,AUC of △MELD was 0.871 in predicting short-term prognosis,which was higher than that of △MELD-Na (Z =4.229,P ＜0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 4.5 was 89.9％,and the average survival time was 29.08 d.Conclusion For acute/sub-acute liver failure,MELD,MELD-Na,△MELD and △MELD-Na are all satisfactory in predicting short-term prognosis; for acute-on-chronic liver failure,△MELD and △MELD-Na are better than MELD,MELD-Na scores at the baseline; and for chronic liver failure,△MELD is the best indicator.

From 1982 to 1988, we have performed supraglottic horizontal partial laryngectomy for 41 cases of laryngeal carcinoma. 19 of them were males and 22 females. 40 cases of squamous cell carcinoma accounted for 97.6%,and 75.6% of cases were in second or third stage. All the cases have been followed up. The three-year survival rate is 93.7%, the five-year survival rate is 86.5%. 95% of the patients retained their phonation ability. Decannulation rate of tracheostomy tube is 65.9%. Normal deglutition ability is found in 90.2% of cases. Indications for operation, postoperative complications, late results, and failure of removal of tracheostomy tube are discussed.

Objective To develop a hyperthermia temperature control system for the treatment of pelvic inflammatory disease. Methods Temperature was controlled by using PWM method based on a single chip computer. The system was heated by using heating wire. In the whole cycle of T, the heating wire's work time was divided into three different stages according to different temperature of system: in the lower temperature, the duty cycle of the heating wire's work time was 100%; when the system temperature entered to a certain stage, a control variable was obtained through the PID algorithm which was used to compare the difference between the current temperature and the temperature requirements. The control variable determined the duty cycle of the heating wire's work time: the more close to the temperature required for the temperature of system, the duty cycle of the heating wire's work time was more close to 0; if the temperature exceeded a predetermined value, then the heating wire would not heat in the whole cycle. Results The accuracy of the temperature control system was ?0.2 ℃, the overshoot of the temperature control system was ?0.3 ℃, and the response time of the temperature control system was 500 seconds. Conclusion The temperature control method has high precision, small overshoot, and the right response time, which can meet the requirements of constant temperature of hyperthermia treatment. Besides, it is simple and cheap.

Objective To detect altered levels and clinical significance of serum miR-216a and prognosis monitoring in acute pancreatitis (AP) patients.Methods Serum miR-216a levels were determined by quantitative reverse-transcription PCR (qRT-PCR) assay among 80 mild acute pancreatitis (MAP) patients,80 severe acute pancreatitis (SAP) patients and 74 healthy controls.And amylase (AMY),lipase (LPS),Ca2+,glucose (Glu),hematocrit (HCT),triglyceride (TG),total cholesterol (TC) and C reactive protein (CRP) were measured by biochemical analyzer.The clinical usefulness of miR-216a for AP patients was assessed by ROC curve analysis and correlation analysis.Results Compared with healthy controls (11.12 × 10-5 [5.83 × 10-5,19.12 × 10-5],the serum miR216a levels were significantly increased in AP patients(38.49 × 10-5 [24.05 × 10-5,62.02 × 10-5],(U =-9.10,P ＜ 0.01) . The serum miR-216a levels in MAP and SAP patients were (36.46 × 10-5 [22.29 × 10-5,55.80 × 10-5] vs 40.44 × 10-5 [25.84 × 10-5,65.48 × 10-5]),there was no significant difference between MAP and SAP patients (U =-0.96,P ＞ 0.05).The areas under ROC curve (AUCROC) of miR-216a for differential healthy controls and AP patients was 0.870 (95％ CI:0.825-0.915),cut-off value is 0.61.AUCROC of miR-216a for differential healthy controls and MAP patients was 0.865 (95％ CI:0.808-0.921),cut-off value is 0.59.And AUCROC of miR-216a for differential healthy controls and SAP patients was 0.876 (95％ CI:0.822-0.930),cut-off value is 0.66.Moreover,after the clinical improvement of the patients,the levels of serum miR-216a were significantly lowered from (41.88 × 10-5 [24.24 × 10-s,64.44 × 10-5]) to (20.58 × 10-5 [11.01 × 10-5,41.91 × 10-5]),the differences was significant(U =5.24,P ＜ 0.0l).Correlation analysis showed that miR-216a was positively correlated with CRP (r =0.215,P =0.006) in AP patients.Conclusion The levels of miR-216a in serum of AP patients were increased,which is a potential biomarker for the diagnosis and prognosis monitoring of AP.

Objective To understand the status quo of midwives' core competency in Fujian Province and analyze its influencing factors.Methods A total of 374 midwives from 13 hospitals in Fujian Province were surveyed by the midwife core competency scale.Results The average score of midwives' core competency were(3.96±0.54).The scores of vocational literacy,postnatal care skills and health care skills during pregnancy were relatively high.The scores of public health care knowledge,public health care skills and women's health knowledge were relatively low.The scores of core competence for junior,senior and expert abilities for midwives were (4.03±0.55),(3.78±0.59)and (3.54±0.75),respectively.In seven dimensions,the scores for skills were all higher than those for knowledge.Multivariate stepwise regression analysis showed that years of working,hospital grade,marital status and form of employment were influencing factors of midwives' core competency (P＜0.05).Conclusion The core competence of midwives in 13 hospitals in Fujian Province was generally at the middle level.The junior ability was satisfactory,and the senior and expert abilities should be improved.Midwives who were newly employed,working in primary institutes,non-institution personnels should be paid more attention in order to promote midwives' core competency holistically.

Objective:To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for treatment of duodenal lesions.Methods:A retrospective analysis was performed on the data of 45 patients with 46 duodenal lesions who underwent ESD at the Second Xiangya Hospital of Central South University from January 2011 to May 2019. The lesion features, en bloc resection rate, complete resection rate, complications, postoperative pathology and recurrence were assessed.Results:Among the 45 patients, 20 were males and 25 were females, with age of 52.0±11.8 years. Of the 46 lesions, 31 (67.4%) were located in the duodenal bulb, 12 (26.1%) in the descending part, and 3 (6.5%) at the junction of bulb and descending part. The diameter of the lesions was 2.4±1.9 cm. There were 14 (30.4%) lesions originated from mucosal layer, 29 (63.1%) from submucosal layer, and 3 (6.5%) from muscularis propria.Postoperative pathology showed 11 (23.9%) cases of Brunner gland tumors, 9 (19.6%) neuroendocrine tumors, 5 (10.9%) ectopic pancreas, 5 (10.9%) lipomas, and 16 (34.8%) other pathological patterns. All 45 patients with 46 lesions underwent ESD successfully, and the en bloc resection rate was 100.0% (46/46), complete resection rate was 91.3% (42/46). Intraoperative bleeding occurred in 1 case (2.2%), which was successfully treated by endoscopy. One (2.2%) delayed perforation occurred and was treated by surgical intervention. Electrocoagulation syndrome occurred in 1 case (2.2%), which was relieved after conservative medical therapy. Two cases received further surgery after ESD. The mean hospital stay was 6.2 days (ranged 2-21 days) and no death occurred. Forty-one cases were followed up for 1-78 months, with mean time of 30 months. During the follow-up period, local recurrence occurred in 1 patient (2.4%).Conclusion:ESD is an effective and safe treatment for duodenal lesions and has a good clinical practical value.

Objective: To evaluate the vitamin D nutritional status in Chinese women of child-bearing age by analyzing serum 25-hydroxyvitamin D level in 2010-2012. Methods: Data were obtained from the China Nutrition and Health Survey in 2010-2012. Using cluster sampling and proportional stratified random sampling, 1 514 women of child-bearing age (18-44 years old) from 34 metropolis and 41 small and medium-sized cities were included in this study. Demographic information was collected by questionnaire and serum 25-hydroxyvitamin D concentration was determined by radioimmunoassay, in accordance with the 2010 Institute of Medicine of the National Academies standards. We compared differences in vitamin D levels, specifically serious deficiency, lack of deficiency, insufficiency, and excess. Results: The overall serum 25-hydroxyvitamin D level of Chinese urban women of child-bearing age (P₅₀ (P₂₅-P₇₅)) was 20.1 (15.1-26.3) ng/ml; minorities had a significantly higher serum 25-hydroxyvitamin D level of 22.0 (15.9-27.5) ng/ml compared with women of Han nationality (19.8 (14.9-26.2) ng/ml) (χ²=7.02, P=0.008). The proportions of women with serious deficiency, lack of deficiency, insufficiency, and excess vitamin D were 11.6% (n=175), 37.9% (n=574), 35.1% (n=531), and 0.3% (n=5), respectively. Only 15.1% (n=229) of women of child-bearing age had normal vitamin D nutritional status. No significant differences in vitamin D nutritional status were observed according to age, body mass index, city, nationality, educational level, marital status, or household income per capita (P>0.05). Conclusion Most Chinese urban women of child-bearing age have poor vitamin D levels and require vitamin D supplementation.

ObjectiveTo analyze the epidemiological characteristics of varicella in Yangpu District， Shanghai from 2005 to 2022， predict the trend of varicella in Yangpu District in 2023， and provide evidence for prevention and control of varicella outbreaks. MethodsInformation of varicella cases reported in Yangpu District from 2005 to 2022 was obtained from the China Information System for Disease Control and Prevention. Descriptive statistics was used to characterize the varicella epidemiology. An autoregressive integrated moving average （ARIMA） model was established by using the number of cases per month from 2005 to2022 to predict the trend of varicella epidemics in Yangpu District in 2023. The varicella incidence in 2022 was used to evaluate the fitness of the ARIMA model. ResultsFrom January 2005 to December 2021， a total of 11 527 cases of varicella were reported in Yangpu District， Shanghai. After excluding duplicates and clinical diagnoses， 11 413 cases were included into the analysis. The annual average incidence rate was 51.87/10⁵， the age of onset was mainly under 20 years old （66.5%）， and the occupation was mainly students （49.7%）. The ARIMA （1，1，0）×（0，1，1）₁₂ model was constructed and showed a good fitness while using monthly reported varicella cases in 2022 for model fitting. It was predicted that 1 089 cases of varicella would be reported in Yangpu District in 2023. ConclusionIt is predicted that varicella cases in Yangpu District will increase in 2023. It is recommended to continue promoting delayed varicella vaccination to maintain a high level of vaccination rate. Before the peak of the epidemic， health education regarding varicella should be strengthened， and measures for epidemic prevention and control should be reinforced to prevent varicella outbreaks.

Acute pancreatitis （AP） is a gastrointestinal disease that requires early intervention， and when it progresses to moderate-severe AP （MSAP） or severe AP （SAP）， there will be a significant increase in the mortality rate of patients. Machine learning （ML） has achieved great success in the early prediction of AP using clinical data with the help of its powerful computational and learning capabilities. This article reviews the research advances in ML in predicting the severity， complications， and death of AP， so as to provide a theoretical basis and new insights for clinical diagnosis and treatment of AP through artificial intelligence.

With persistent breakthrough and maturity of surgical procedures and postoperative immunosuppressive therapy, the survival rate of liver transplant recipients and grafts has been significantly increased. The shortage of donor liver has become the main obstacle for clinical development of liver transplantation. How to expand the source of donor liver has become an urgent issue. Groundbreaking progresses have been made in the use of common marginal donor livers in clinical liver transplantation, such as elderly donor liver, steatosis donor liver, viral hepatitis donor liver and liver from donation after cardiac death. Nevertheless, multiple restrictions still exist regarding the use of marginal donor liver. Consequently, the definition of marginal donor liver and research progress in the application of common marginal donor livers were reviewed, and the opportunities and challenges of mariginal donoor liver were illustrated, aiming to provide reference for expanding the donor pool for clinical liver transplantation and bringing benefits to more patients with end-stage liver disease.