Objective:To observe the correlation between serum immunoglobulins levels with the disease severity and nutritional indexes in elderly patients with heart failure.Methods:The clinical data of 53 elderly patients with heart failure (observation group) from October 2020 to January 2022 in the Affiliated Hospital of Ningbo University Medical College were retrospectively analyzed, and 53 cases of health examination at the same time were selected as the control group. The disease severity was assessed by a 6-minute walk test (6MWT), and nutritional status was assessed by nutritional index. The serum levels of IgA, IgM and IgG were measured by PUZS-300 fully automated biochemical analyzer; the serum nutrient indexes were measured by enzyme linked immunosorbent assay, including total protein, albumin and proalbumin. Pearson method was used for correlation test; the value of IgA, IgM and IgG in predicting disease severity in elderly patients with heart failure was analyzed by the receiver operating characteristic (ROC) curve.Results:The IgA, IgM and IgG in observed group were significantly higher than those in control group: (4.31 ± 1.50) g/L vs. (1.63 ± 0.71) g/L, (18.50 ± 3.93) g/L vs. (11.33 ± 1.12) g/L and (4.58 ± 1.26) g/L vs. (1.96 ± 0.36) g/L, and there were statistical differences ( P<0.01). The 6MWT result showed that 23 cases were with mild status, 18 cases moderate, and 12 cases severe. The IgA, IgM and IgG in moderate and severe patients were significantly higher than those in mild patients: (4.34 ± 0.78) and (6.38 ± 0.91) g/L vs. (3.23 ± 0.94) g/L, (18.90 ± 2.09) and (23.81 ± 2.78) g/L vs. (15.44 ± 2.03) g/L, (4.77 ± 0.56) and (6.47 ± 0.34) g/L vs. (3.45 ± 0.44) g/L, the indexes in severe patients were significantly higher than those in moderate patients, and there were statistical differences ( P<0.05). Pearson correlation analysis result showed that IgA, IgM and IgG were positively correlated with disease severity in elderly patients with heart failure ( r = 0.801, 0.830 and 0.925; P<0.01). The nutritional index result showed that malnutrition was in 25 cases, and normal nutrition in 28 cases. The IgA, IgM and IgG in patients with malnutrition were significantly higher than those in patients with normal nutrition: (4.89 ± 0.80) g/L vs. (1.98 ± 0.69) g/L, (19.45 ± 2.01) g/L vs. (12.01 ± 1.28) g/L and (4.88 ± 0.59) g/L vs. (2.01 ± 0.47) g/L, the nutritional index, total protein, albumin and proalbumin were significantly lower than those in patients with normal nutrition: (49.44 ± 6.98) scores vs. (58.34 ± 8.12) scores, (62.87 ± 5.20) g/L vs. (66.74 ± 4.54) g/L, (33.21 ± 2.64) g/L vs. (39.12 ± 3.11) g/L and (185.55 ± 16.72) mg/L vs. (196.33 ± 18.90) mg/L, and there were statistical differences ( P<0.01 or <0.05). Pearson correlation analysis result showed that the IgA and IgM were negatively correlated with nutritional index, total protein, albumin and proalbumin in elderly patients with heart failure (IgA: r = - 0.456, - 0.353, -0.620 and -0.281; IgM: r = -0.445, -0.327, -0.611 and -0.321; P<0.01 or <0.05); IgG was negatively correlated with nutritional index, total protein and albumin ( r = - 0.425, - 0.359 and - 0.646; P<0.01), and it had no correlation with proalbumin ( P>0.05). ROC curve analysis result showed that the areas under the curve of IgA, IgM and IgG in predicting disease severity in elderly patients with heart failure were 0.891, 0.943 and 0.838, sensitivity of 76.70%, 90.00% and 73.33%, and specificity of 87.00%, 87.00% and 100.00%. Conclusions:The serum levels of IgA, IgM and IgG increased significantly in elderly patients with heart failure, who were also with abnormal immune function and decreased nutritional status. The serum levels of IgA, IgM and IgG correlate with disease severity and nutritional indexes.

Objective:To explore the effect of calcium phosphate cement（CPC）scaffold loaded with emodin（EMO）on osteogenic activity of osteoblasts.Methods:The bone cement scaffold was prepared by mixing EMO powder and CPC powder（ratio 1∶9），adding citric acid and then was poured into polytetrafluoroethylene mold（EMO-CPC group）. A dose of 0.36 g CPC powder was mixed with citric acid and injected into the polytetrafluoroethylene mold（CPC group）. General morphology，setting time（initial setting time and final setting time），injection rate and compressive strength of stents were compared between the two groups. Primary osteoblasts were extracted and co-cultured with two sets of scaffolds. After co-culture for 3 days，their characterization was observed by scanning electron microscopy. Live/dead cell staining and 3-（4,5-dimethylthiazole-2）-2,5-diphenyltetrazolium bromide（MTT）colorimetric method were used to detect cell viability，toxicity and proliferation activity of scaffolds. Two sets of scaffolds were stained with immunofluorescence for osteopontin（OPN），and protein expression was observed under an inverted fluorescence microscope. After co-culture for 7 days，tetrazolium nitro blue/5-bromo-4-chloro- 3-indolyl-phosphate（NBT/BCIP）staining method was used for alkaline phosphatase（ALP）staining. After co-culture for 14 days，two sets of scaffolds were stained with Alizarin Red to detect their osteogenic activity.Results:Two sets of stents showed relatively smooth and flat topography under the scanning electron microscope. There were no significant differences in initial setting time，final setting time，injection rate and compressive strength of stents between two groups（ P > 0.05）. After co-culture for 3 days，the osteoblast clusters were adhered to the surface of the EMO-CPC scaffold，with good shape. Viable cell rate reached（98.2 ± 0.1）% in EMO-CPC group and（90.2% ± 0.1）% in CPC group（ P <0.05）. Cell proliferation activity in EMO-CPC group was stronger than that in CPC group（ P < 0.05）. OPN-specific staining showed that EMO-CPC group had stronger OPN protein fluorescence expression compared to CPC group. After co-culture for 7 days，expression of ALP in EMO-CPC group was higher than that in CPC group. After co-culture for 14 days，staining intensity of Alizarin Red in EMO-CPC group was more significant than that in CPC group. Conclusions:The EMO-CPC scaffold can provide a suitable environment for the growth of osteoblasts for it has better biocompatibility，cell proliferation and osteogenic activity than the CPC scaffold.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective To forecast the number of healthcare professionals at China′s primary medical institutions from 2016 to 2020 ,so as to provide the healthcare authorities with references for optimizing healthcare human resource allocation .Methods The Grey model was used to predict numbers of healthcare professionals in China from 2016 to 2020 on the base of health technicians data from 2010 to 2015 .Results The forecast results show that the number of healthcare professionals may be increased to about 600000 people a yearfrom 2015 to 2020 .The number of healthcare professionals at China′s primary medical institutions is expected to grow about 204000 people a year ,and general practitioner is increased to about 22000 people a year .The annual growth rates of medical(assistant) practitioners ,medical practitioners ,registered nurses ,pharmaceutical personnel and examiners in China are expected to be 3.20％ ,2.81％ ,6.88％ ,1.53％ and 2.16％ respectively. The annual average growth rates of postgraduates ,undergraduates and junior college graduates are expected to be 16.95％ ,12.08％ and 5.46％ respectively .Conclusions in the future ,the requirements for healthcare professionals at primary institutions will still be higher than demand in China ,with a gap to be filled and their professional makeup and academic title make to be optimized. Therefore greater efforts are required for their development to enhance their competence and professionalism ,with reasonable staffing of the human resources .