To establish an HPLC method to determine osimertinib mesylate,Agilent ZORBAX Eclipse Plus C18 column (4.6 mm × 250 mm,5 μm) was used with a mobile phase consisting of methanol-buffer solution (20 mmoL/L NaH2PO4,pH 3.0 adjusted with 85％ H3PO4) (50 ∶ 50) at the flow rate of 1.0 mL/min.The detection wavelength was 210 nm,and the column temperature was kept at 35 ℃.The calibration curve was liner over the range from 50％ to 150％ of determination concentration (0.201 1-0.603 2 mg/mL,r =0.999 9).The limit of quantitation (LOQ) and limit of detection (LOD) were 0.32 μg/mL and 0.08 μg/mL,respectively.The contents of osimertinib mesylate in samples were 100.1％,99.5％ and 99.7％.Good chromatographic separation of osimertinib mesylate and its related substances,including synthetic impurities and degradation products,were obtained.The established HPLC method is specific,accurate,simple and durable,and could be used for the determination of osimertinib mesylate.

[Objective] To investigate the relation among the polymorphism of interleukin-8 (IL-8) gene A-251T and apolipoprotein E (ApoE) gene with late-onset Alzheimer's disease (LOAD). [Methods] Polymerase chain reaction and restrietive fragment length polymorphism (PCR-RFLP) were used to detect the polymorphism distribution of IL-8 gene A-251T and ApoE gene of 185 people in Han ethnicity of Guangdong province (study group: 88 LOAD patients, eontrolled group: 97 people). The correlation of these genes was analyzed. [Results] (1) The differences of genotypes and alleles of IL-8 gene A-251T between study group and controlled group had no statistical significance. (2) The frequency of ApoE 64 allele in study group was significantly higher than that in controlled group, as risk factor of LOAD (OR=2.272, P=0.003). (3) Study group and controlled group were both divided into two groups by carrying ApoE ε4 allele or not. The differenees of IL-8 genotypes were no significant whether in carrying ApoE ε4 allele group or not (carrying ε4 group: P=0.965; no carrying ε4 group: P=0.523). [Conclusion] It is suggested that lL-8 gene A-251T polymorphism perhaps has no relation with LOAD and has no interaction with ApoE ε4 allele.

Objective:To summarizes the evidence of oral and nasal care for adult inpatients during nasal tube feeding and provide reference for clinical implementation.Methods:The relevant evidence on oral and nasal care of adult patients with nasal feeding were systematically searched on UpToDate, Joanna Briggs Institute (JBI) Evidence-based Healthcare Center, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence, Medlive.cn, Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang database and other databases and guideline websites. The retrieval period was from January 1, 2016 to August 28, 2020. After the methodological quality evaluation of the included clinical practice guidelines, expert consensus, systematic evaluation, clinical decision-making and evidence summary, the literature that met the standards was extracted and the evidence was summarized according to the professional clinical judgment of the researchers.Results:A total of 13 literatures were included, including 1 guideline, 2 expert consensus, 3 systematic evaluation, 2 clinical decision making and 5 evidence summaries. After sorting out, 16 best evidences were summarized from 4 aspects such as professional training of nursing staff, factors affecting oral and nasal hygiene, assessment and nursing of nasal, assessment and nursing of oral.Conclusions:Through the standardized evidence collection and formulation method, this paper summarizes the relevant evidence of oral and nasal nursing for patients with enteral nutrition through nasal tube feeding from 4 aspects. Medical staff should strengthen the training of professionals, find out the factors affecting the oral and nasal health of adult inpatients undergoing nasal tube feeding as soon as possible and take effective measures to evaluate and care the patients' oral and nasal cavity according to the best evidence.

Objective:To explore the effects of 30° and 45° angles on the time and comfort of mechanical ventilation and extubation for patients undergoing abdominal surgery.Methods:A total of 64 patients who underwent oral tracheal intubation at SICU in the General Surgery Center of the Critical Care Medical Center of our hospital from January 2018 to November 2018 were selected. A total of 64 patients were randomly divided into group A and group B by random number table method, of which there were 31 people in group A and 33 people in group B. During the experiment, 1 people in group A and 3 people in group B experienced dyspnea during the withdrawal process and terminated treatment. Finally, 30 patients in group A and 30 patients in group B were selected. The bedside angle during group A treatment was 30°, and the bedside angle during group B treatment was 45°. The bedside angle card was used by both groups to measure the height of the bedside during the weaning. The two groups of patients were compared during the weaning period (improved Visual Analogue Scale score), weaning to extubation time, aspiration rate, intubation time, pressure ulcer rate, pulmonary function and hemodynamic changes after extubation.Results:Patients with ventilator to extubation time, during the machine during oxygenation index, pulled machine comfort score in group A were 117.50 (45.25, 189.00) min, (348.20±59.72) mmHg(1 mmHg=0.133 kPa), 1.00 (1.00, 2.00) points, group B were respectively 30.00 (13.50, 42.75) min, (314.60±67.13) mmHg and 3.00 (2.00, 3.00) points, two groups comparing the difference was statistically significant ( Z values was -2.411, -4.806, t value was 2.048, P<0.05 or 0.01). Conclusion:Lifting the bedside 30° during mechanical ventilation withdrawal in patients with abdominal surgery can shorten the time from patient withdrawal to extubation, improve the patient's oxygenation index, and improve the comfort during patient withdrawal. It can be used as an early patient for abdominal surgery. One of the auxiliary intervention measures for withdrawal.

Objective To investigate the contents and features of drug-induced liver injury (DILI)database called LiverTox,as well as 37 herbal preparations included in this database.Methods Firstly,the source and contents of LiverTox were briefly introduced,including the clinical features,types,severity,and causality assessment scale of DILI.Secondly,detailed information of 37 herbal preparations included in the class of "Herbals and Dietary Supplements" were extracted,including drug name,origin,efficacy,constituents,type of liver injury,and manifestations,to perform a preliminary statistical analysis.Finally,a comparative analysis was performed between such information and current knowledge of Chinese herbal medicine-induced liver injury in China.Results LiverTox was a DILI database with open access and rich information and provided practical information on treatment,typing,causality assessment,and treatment.Among the 37 herbal preparations,28 had the risk of liver injury.The most common indication was weight loss,followed by arthritis and constipation.The latency of hepatotoxicity ranged from 4 weeks to 6 months.Compared with the current knowledge in China,there were differences in the varieties and indications for herbal preparations with hepatotoxicity included in LiverTox,and many herbals with acknowledged hepatotoxicity in China were not included.Conclusion LiverTox database is concise and practical,but there are certain differences between the herbal preparations included in this database and current knowledge in China.

Objective The aim of the study was to evaluate the hearing performance of a new transcutaneous bone conduction hearing aid.Methods One hundred and nine patients with conductive or mix hearing loss and eleven patients with single sided sensorineural hearing loss from four tertiary referral centers were tested under unaided and aided conditions with the sound processors on testbands.Free field test was performed to obtain the hearing thresholds and speech recognition thresholds in quiet.Adverse events were also documented by a self-reported questionnaire.Results ①Conductive or mixed hearing loss patients:for aged≥6 yrs subgroup,the bone conduction PTA average of aided sides was 18.55±8.99 dB HL.For aged<6 yrs subgroup, the bone conduction ABR hearing threshold average was 18.33±8.36 dB HL.②Statistically significant improvements in free field hearing thresholds were seen when compared aided hearing with unaided outcomes.The average PTA (pure tone average in free field) was measured at 32.21±10.00, 37.33±14.15, and 34.38±10.76 dB HL respectively in conductive or mixed hearing loss aged≥6 yrs subgroup;aged<6 yrs subgroup and SSD subgroup.③In aided situations;speech recognition thresholds in quiet were significantly better compared to unaided situation in patients aged≥6yrs.④None of patients presented adverse events related to the devices.Conclusion The Sophono bone conduction hearing aid has satisfactory hearing performance and can be considered an alternative device for patients with conductive or mix hearing loss or with SSD.

Objective:To establish a decision tree model of pediatric complicated appendicitis (CA) based on Pediatric Appendicitis Score (PAS) combined with inflammatory indicators, and to evaluate its clinical application efficacy in pediatrics.Methods:The clinical data of 544 children diagnosed with appendicitis in Children′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was retrospectively analyzed. According to postoperative pathology, the children were divided into uncomplicated appendicitis group and CA group. The independent risk factors of CA were screened by univariate and multivariate logistic regression analysis, and these parameters were included to establish the decision tree model. The accuracy of the decision tree model was verified by receiver operating characteristic (ROC) curve.Results:Binary logistic regression analysis indicated that the PAS, C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were identified as independent risk factors for complicated appendicitis in children (all P<0.05). PAS, CRP and NLR were included as covariables to construct the decision tree model and binary logistic regression model for predicting CA. The decision tree demonstrated an overall accuracy of 79.2% with a sensitivity of 86.7% and specificity of 71.9%, and achieved an area under curve (AUC) of 0.821(95% CI: 0.786-0.857). The binary logistic regression model had a sensitivity of 79.6% and specificity of 69.1%, with an overall accuracy of 75.1% and achieved an AUC of 0.808(95% CI: 0.770-0.845). Conclusions:The decision tree model based on PAS score combined with CRP, NLR is a simple, intuitive and effective tool , which can provide pediatric emergency physicians a reliable basis for diagnosis of pediatric CA.

Objective:To investigate the association between the single nucleotide polymorphisms (SNPS) at rs1695 and rs6591256 in glutathione S-transferase P1 (GSTP1) gene and susceptibility to noise-induced hearing loss in Chinese Han workers exposed to noise.Methods:Using the 1: 1 nested case-control study and taking 6297 workers exposed to noise in a steel plant in Henan province as the cohort study population in July 2019, we screened those who have been exposed to noise for ≥3 years and whose binaural high frequency (3000, 4000, 6000 Hz) average hearing threshold is ≥40 dB (A) into the case group. The control group was selected according to the matching criteria of the same sex, same type of work, and the age difference was not more than 5 years old, and the working age difference was not more than 2 years. 276 subjects were selected into the case group and the control group respectively. The medium and high throughout single nucleotide polymorphism typing technology (SNPscanTM technology) was used to detect the polymorphism of three nucleotide sites of GSR gene, and conditional logistic regression was used to analyze the relationship between single nucleotide polymorphism (SNP) and NIHL, and the relationship between different polymorphic sites and the risk of NIHL after adjusting covariates. After stratification with different cumulative noise exposure (CNE) , Conditional logistic regression analysis was used to analysis the risk of NIHL at different loci.Results:The mean and standard deviation of age of the selected subjects was (40.28±8.00) , the mean and standard deviation of noise-exposed working years was (18.7±8.92) years. The range of noise exposure levels and comulative noise exposure were 80.05-93.35dB (A) and 86.83-107.92 dB (A) ·year, respectively. Compared with the control group, there were no statistically significant differences in age, noise-exposured working years, intensity of noise exposure, CNE, gender, drinking, hypertension prevalence and noise exposure level in the hearing loss group ( P>0.05) , while there were statistically difference in smoking, binaural high-frequency average hearing threshold and binaural speech frequency ( P<0.05) . After adjusting for smoking, drinking, hypertension and other factors, in the co-dominant model, compared with GGgenotype, the risk of NIHL was higher in rs1002149 GT genotype and rs2251780 GA genotype ( OR=1.558, 95% CI: 1.028-2.361; OR=1.550, 95% CI: 1.020-2.355, P<0.05) ; compared with TT/GT genotype, the rs1002149 TT genotype has a higher risk of developing NIHL ( OR=1.494, 95% CI: 1.002-2.228, P<0.05) , while rs3779647 genotype had no relationship with the risk of NIHL ( P>0.05) . In the equivalent sound level (L Aeq) of noise >85 dB (A) stratification, compared with GG genotype, carrying rs1002149 GT genotype and rs2251780 GT genotype has higher risk of nihl ( OR=1.801, 95% CI: 1.093-2.967; OR=1.720, 95% CI: 1.050-2.817, P<0.05) . Haplotype analysis of two sites, rs1002149 and rs2251780, was not found to be related to NIIHL susceptibility. Conclusion:The allele G of rs1695 and rs6591256 may be risk factors of NIHL.

Objective:To investigate the association between the single nucleotide polymorphisms (SNPS) at rs1695 and rs6591256 in glutathione S-transferase P1 (GSTP1) gene and susceptibility to noise-induced hearing loss in Chinese Han workers exposed to noise.Methods:Using the 1: 1 nested case-control study and taking 6297 workers exposed to noise in a steel plant in Henan province as the cohort study population in July 2019, we screened those who have been exposed to noise for ≥3 years and whose binaural high frequency (3000, 4000, 6000 Hz) average hearing threshold is ≥40 dB (A) into the case group. The control group was selected according to the matching criteria of the same sex, same type of work, and the age difference was not more than 5 years old, and the working age difference was not more than 2 years. 276 subjects were selected into the case group and the control group respectively. The medium and high throughout single nucleotide polymorphism typing technology (SNPscanTM technology) was used to detect the polymorphism of three nucleotide sites of GSR gene, and conditional logistic regression was used to analyze the relationship between single nucleotide polymorphism (SNP) and NIHL, and the relationship between different polymorphic sites and the risk of NIHL after adjusting covariates. After stratification with different cumulative noise exposure (CNE) , Conditional logistic regression analysis was used to analysis the risk of NIHL at different loci.Results:The mean and standard deviation of age of the selected subjects was (40.28±8.00) , the mean and standard deviation of noise-exposed working years was (18.7±8.92) years. The range of noise exposure levels and comulative noise exposure were 80.05-93.35dB (A) and 86.83-107.92 dB (A) ·year, respectively. Compared with the control group, there were no statistically significant differences in age, noise-exposured working years, intensity of noise exposure, CNE, gender, drinking, hypertension prevalence and noise exposure level in the hearing loss group ( P>0.05) , while there were statistically difference in smoking, binaural high-frequency average hearing threshold and binaural speech frequency ( P<0.05) . After adjusting for smoking, drinking, hypertension and other factors, in the co-dominant model, compared with GGgenotype, the risk of NIHL was higher in rs1002149 GT genotype and rs2251780 GA genotype ( OR=1.558, 95% CI: 1.028-2.361; OR=1.550, 95% CI: 1.020-2.355, P<0.05) ; compared with TT/GT genotype, the rs1002149 TT genotype has a higher risk of developing NIHL ( OR=1.494, 95% CI: 1.002-2.228, P<0.05) , while rs3779647 genotype had no relationship with the risk of NIHL ( P>0.05) . In the equivalent sound level (L Aeq) of noise >85 dB (A) stratification, compared with GG genotype, carrying rs1002149 GT genotype and rs2251780 GT genotype has higher risk of nihl ( OR=1.801, 95% CI: 1.093-2.967; OR=1.720, 95% CI: 1.050-2.817, P<0.05) . Haplotype analysis of two sites, rs1002149 and rs2251780, was not found to be related to NIIHL susceptibility. Conclusion:The allele G of rs1695 and rs6591256 may be risk factors of NIHL.

Objectives:To explore the changes of some peripheral blood cells related to inflammation in patients with non-arteritis central retinal artery occlusion (NA-CRAO).Methods:A retrospective clinical study. From July 2019 to July 2021, a total of 218 patients with NA-CRAO hospitalized (NA-CRAO group) in Department of Ophthalmology, Xi'an People's Hospital (Xi'an Fourth Hospital) and 218 patients with routine physical examination (control group) during the same period were included in the study. There were no significant differences in age ( t=0.60), sex composition ratio ( χ2=0.83) and body mass index ( t=0.77) between the two groups ( P>0.05). 0.2 ml fasting peripheral blood was collected from the subject, and white blood cells (WBC), neutrophils (NEUT), lymphocytes (LYMPH), red blood cells (RBC), RBC distribution width (RDW), platelets (PLT), mean PLT volume (MPV), and large PLT ratio (PLCR) were detected. The NEUT/LYMPH ratio (NLR) and PLT/LYMPH ratio (PLR) were calculated. t test was used to compare measurement data between groups. Multiple logistic regression analysis was performed for blood cells with P <0.05. The receiver operating characteristic curve (ROC curve) was used to calculate the area under the curve (AUC) and 95% confidence interval (95% CI) of each inflammatory indicator, and the optimal cutoff value was determined according to the Jorden index (sensitivity+specificity-1). Results:Compared with control group, WBC, NEUT, NLR, RDW, PLR were increased in NA-CRAO group, while RBC and LYMPH were decreased, with statistical significance ( t=9.68, 12.43, 9.47, 3.64, 5.54, 5.18, 0.46; P<0.001). There was no significant difference in PLT, MPV and PLCR between the two groups ( t=0.32, 1.56, 0.84; P>0.05). Multivariate logistic regression analysis showed that NLR was a possible risk factor for the occurrence of NA-CRAO (odds ratio=2.51, 95% CI 0.780-0.859, P=0.031). ROC curve analysis showed that the AUC predicted by NLR was 0.819, the optimal critical value was 3.05, and the sensitivity and specificity were 59.2% and 92.7%, respectively. Conclusions:In peripheral blood cells of NA-CRAO patients, NEUT is significantly increased and LYMPH is decreased. NLR is a possible risk factor for NA-CRAO.