Objective:To investigate the diagnostic value of urine pH, serum uric acid and related clinical indicators in the diagnosis of urinary infection stones, and to construct a prediction nomogram.Methods:The clinical data of 432 patients with urinary calculi admitted to Xuzhou Central Hospital from August 2018 to November 2023 were retrospectively analyzed. The study included 289 males and 143 females, with an average age of (52.72±13.46) years old. Among the patients, there were 98 cases of hypertension, 67 cases of diabetes, and 100 cases of recurrent calculi. Kidney stones were present in 152 cases, ureteral stones in 242 cases, and bladder stones in 38 cases. Urine bacterial culture yielded positive results in 97 cases. According to the results of postoperative stone composition analysis, the two groups were categorized as infection and no-infection stone groups, and the differences in general data between the two groups were compared. Univariate and multivariate logistic regression analysis were conducted to assess the diagnostic value of urine pH, serum uric acid, and related clinical indicators for urinary infection stones. Receiver operating characteristic (ROC) curve and area under curve (AUC) were utilized to evaluate the clinical significance of urine pH, serum uric acid, and combined indexes in preoperatively diagnosing urinary infection stones, as well as constructing a nomogram prediction model.Results:There were 127 cases of infection stones and 305 cases of no-infection stones. The infection stone group exhibited a higher urine pH value [7.0(6.5, 7.5) vs. 6.0(5.5, 6.5), P<0.001], lower serum uric acid levels [(301.38±70.12) vs. (358.88±88.99) μmol/L, P<0.001], a higher proportion of females [55.1%(70/127) vs. 23.9%(73/305), P<0.001], younger age [(48.36±14.83)vs. (53.12±12.61)years old, P<0.001], a higher proportion of recurrence stones [34.6 %(44/127) vs. 18.4%(56/305), P<0.001], and a higher rate of positive urine bacteria culture[29.9%(38/127)vs. 19.3%(59/305), P=0.016]and nitrite test results [18.9%(24/127)vs. 6.3%(19/305), P <0.001]. Univariate logistic regression analysis revealed that urine pH value, serum uric acid levels, gender, age, recurrent stones, urine bacterial culture, and urine nitrite were associated with urinary infection stones ( P< 0.05). Multivariate logistic regression analysis revealed that urine pH value ( OR= 4.836, 95% CI 3.342-6.997), female gender( OR=2.320, 95% CI 1.286-4.186), recurrent stones ( OR=2.225, 95% CI 1.208-4.101), positive urine bacterial culture ( OR=2.061, 95% CI 1.094-3.883), serum uric acid ( OR=0.992, 95% CI 0.949-0.989), age ( OR=0.969, 95% CI 0.949-0.990) were independent risk factors for urinary infection stones ( P<0.05). The combined diagnostic value of six indicators was the highest, with an AUC of 0.874 (95% CI 0.837-0.911). Following this, urine pH exhibited an AUC of 0.818 (95% CI 0.778-0.858), while serum uric acid had an AUC of 0.704 (95% CI 0.652-0.756). The nomogram model was successfully constructed based on the six indicators. The mean AUC of the ROC curve after 1 000 resamples of the Bootstrap method was 0.864 (95% CI 0.828-0.900), and the calibration curve showed that the predicted curve fit the ideal curve well, with a mean absolute error of 0.005 and a Hosmer-Lemeshow test of P>0.05. Clinical decision curve analysis (DCA) showed that the model had a higher net clinical benefit when the model had a threshold probability value≥0.01. Conclusions:Urine pH and serum uric acid are closely related to urinary infection stones. A nomogram model combining these factors with gender, age, recurrent stones, and urine culture results can effectively predict the probability of infection-related stones, providing significant clinical value.

Objective:To investigate the diagnostic value of urine pH, serum uric acid and related clinical indicators in the diagnosis of urinary infection stones, and to construct a prediction nomogram.Methods:The clinical data of 432 patients with urinary calculi admitted to Xuzhou Central Hospital from August 2018 to November 2023 were retrospectively analyzed. The study included 289 males and 143 females, with an average age of (52.72±13.46) years old. Among the patients, there were 98 cases of hypertension, 67 cases of diabetes, and 100 cases of recurrent calculi. Kidney stones were present in 152 cases, ureteral stones in 242 cases, and bladder stones in 38 cases. Urine bacterial culture yielded positive results in 97 cases. According to the results of postoperative stone composition analysis, the two groups were categorized as infection and no-infection stone groups, and the differences in general data between the two groups were compared. Univariate and multivariate logistic regression analysis were conducted to assess the diagnostic value of urine pH, serum uric acid, and related clinical indicators for urinary infection stones. Receiver operating characteristic (ROC) curve and area under curve (AUC) were utilized to evaluate the clinical significance of urine pH, serum uric acid, and combined indexes in preoperatively diagnosing urinary infection stones, as well as constructing a nomogram prediction model.Results:There were 127 cases of infection stones and 305 cases of no-infection stones. The infection stone group exhibited a higher urine pH value [7.0(6.5, 7.5) vs. 6.0(5.5, 6.5), P<0.001], lower serum uric acid levels [(301.38±70.12) vs. (358.88±88.99) μmol/L, P<0.001], a higher proportion of females [55.1%(70/127) vs. 23.9%(73/305), P<0.001], younger age [(48.36±14.83)vs. (53.12±12.61)years old, P<0.001], a higher proportion of recurrence stones [34.6 %(44/127) vs. 18.4%(56/305), P<0.001], and a higher rate of positive urine bacteria culture[29.9%(38/127)vs. 19.3%(59/305), P=0.016]and nitrite test results [18.9%(24/127)vs. 6.3%(19/305), P <0.001]. Univariate logistic regression analysis revealed that urine pH value, serum uric acid levels, gender, age, recurrent stones, urine bacterial culture, and urine nitrite were associated with urinary infection stones ( P< 0.05). Multivariate logistic regression analysis revealed that urine pH value ( OR= 4.836, 95% CI 3.342-6.997), female gender( OR=2.320, 95% CI 1.286-4.186), recurrent stones ( OR=2.225, 95% CI 1.208-4.101), positive urine bacterial culture ( OR=2.061, 95% CI 1.094-3.883), serum uric acid ( OR=0.992, 95% CI 0.949-0.989), age ( OR=0.969, 95% CI 0.949-0.990) were independent risk factors for urinary infection stones ( P<0.05). The combined diagnostic value of six indicators was the highest, with an AUC of 0.874 (95% CI 0.837-0.911). Following this, urine pH exhibited an AUC of 0.818 (95% CI 0.778-0.858), while serum uric acid had an AUC of 0.704 (95% CI 0.652-0.756). The nomogram model was successfully constructed based on the six indicators. The mean AUC of the ROC curve after 1 000 resamples of the Bootstrap method was 0.864 (95% CI 0.828-0.900), and the calibration curve showed that the predicted curve fit the ideal curve well, with a mean absolute error of 0.005 and a Hosmer-Lemeshow test of P>0.05. Clinical decision curve analysis (DCA) showed that the model had a higher net clinical benefit when the model had a threshold probability value≥0.01. Conclusions:Urine pH and serum uric acid are closely related to urinary infection stones. A nomogram model combining these factors with gender, age, recurrent stones, and urine culture results can effectively predict the probability of infection-related stones, providing significant clinical value.

OBJECTIVE: To analyze the clinical characteristics of patients with emergency in-hospital cardiac arrest (IHCA) in Kashgar, Xinjiang Uygur Autonomous Region and the factors affecting the success rate of cardiopulmonary resuscitation. METHODS: Retrospectively selected patients who had cardiac arrest and cardiopulmonary resuscitation in the emergency department of the People's Hospital of 6 counties and cities in Kashgar area from January 2019 to January 2022. The clinical data of all patients were collected, including gender, age, major underlying diseases, the beginning and duration of resuscitation, the number of electric defibrillation acute physiology and chronic health evaluation II (APACHE II). According to whether the resuscitation was successful, all patients were divided into successful resuscitation group and failed resuscitation group. The clinical characteristics of the two groups were compared. Then, the influencing factors of the success rate of cardiopulmonary resuscitation in IHCA patients were analyzed by binary Logistic regression. RESULTS: A total of 1 376 patients were enrolled, including 1 117 cases of failed resuscitation and 259 cases of successful resuscitation. The success rate of resuscitation was 18.82%. Compared with the resuscitation failure group, the patients in the successful resuscitation group were younger (age: 49.10±20.99 vs. 58.44±18.32), the resuscitation start time was earlier [resuscitation start time ≤ 5 minutes: 76.45% (198/259) vs. 66.61% (744/1 117)], the proportion of cardiovascular and cerebrovascular diseases was lower [cardiovascular disease: 49.42% (128/259) vs. 58.19% (650/1 117), cerebrovascular disease: 17.37% (45/259) vs. 21.58% (241/1 117)], the number of electric defibrillation was lower [times: 0 (0, 2) vs. 1 (0, 1)], the proportion of endotracheal intubation was more [80.31% (208/259) vs. 55.60% (621/1 117)], APACHE II score was lower (13.75±8.03 vs. 17.90±4.63), and the difference was statistically significant (all P < 0.01). Binary Logistic regression analysis showed that age, start time of resuscitation, ventilation mode and APACHE II score were protective factors affecting the success rate of cardiopulmonary resuscitation in patients with emergency IHCA [age: odds ratio (OR) = 0.982, 95% confidence interval (95%CI) was 0.973-0.991, P < 0.001; resuscitation start time ≤ 5 minutes: OR = 0.629, 95%CI was 0.409-0.966, P = 0.034; tracheal intubation assisted ventilation: OR = 0.243, 95%CI was 0.149-0.397, P < 0.001; low APACHE II score: OR = 0.871, 95%CI was 0.836-0.907, P < 0.001], while underlying diseases (cardiovascular diseases) are a risk factor affecting the success rate of cardiopulmonary resuscitation (OR = 1.190, 95%CI was 1.015-1.395, P = 0.036). CONCLUSIONS Age, resuscitation start time, ventilation mode, APACHE II score and major underlying diseases (cardiovascular diseases) have a greater impact on the success rate of resuscitation in IHCA patients. The above factors are conducive to improving or formulating more effective rescue strategies for IHCA patients, so as to achieve the purpose of improving the success rate of clinical treatment.
Humans ; Adult ; Middle Aged ; Aged ; Retrospective Studies ; Cardiopulmonary Resuscitation ; Heart Arrest/therapy* ; Electric Countershock ; Hospitals

Background: /Aim: The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend systemic therapy as the only first-line treatment for patients with BCLC stage C hepatocellular carcinoma (HCC) despite its heterogeneity of disease extent. We aimed to identify patients who might benefit from combined transarterial chemoembolization (TACE) and radiation therapy (RT) by subclassifying BCLC stage C. Methods: A total of 1,419 treatment-naïve BCLC stage C patients with macrovascular invasion (MVI) who were treated with combined TACE and RT (n=1,115) or systemic treatment (n=304) were analyzed. The primary outcome was overall survival (OS). Factors associated with OS were identified and assigned points by the Cox model. The patients were subclassified into three groups based on these points. Results: The mean age was 55.4 years, and 87.8% were male. The median OS was 8.3 months. Multivariate analysis revealed a significant association of Child-Pugh B, infiltrative-type tumor or tumor size ≥10 cm, main or bilateral portal vein invasion, and extrahepatic metastasis with poor OS. The sub-classification was categorized into low (point ≤1), intermediate (point=2), and high (point ≥3) risks based on the sum of points (range, 0–4). The OS in the low, intermediate, and high-risk groups was 22.6, 8.2, and 3.8 months, respectively. In the low and intermediate-risk groups, patients treated with combined TACE and RT exhibited significantly longer OS (24.2 and 9.5 months, respectively) than those who received systemic treatment (6.4 and 5.1 months, respectively; P<0.0001). Conclusions Combined TACE and RT may be considered as a first-line treatment option for HCC patients with MVI when classified into low- and intermediate-risk groups.

Objective:To understand the psychological status and nursing needs of maintenance hemodialysis (MHD) patients and provide reference for clinical targeted nursing.Methods:Using the phenomenological research method, a total of 15 patients with MHD in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by the purposive sampling method, and they were given semi-structured individualized interviews. The Colaizzi 7-step analysis method was used to organize the data, extract the inductive themes and analyze the results.Results:The psychological status of MHD patients was repressed fear, despair and helplessness and acceptance. The nursing needs of MHD patients included disease-related knowledge needs, social support needs and health guidance needs.Conclusions:MHD patients have negative psychology. Medical staff need to understand the psychological status and nursing needs of patients and formulate targeted nursing interventions to meet the actual needs of patients and improve the quality of life of them.

Objective:To explore the effect of family-participated dietary management on dietary compliance behavior and nutritional status in elderly maintenance hemodialysis (MHD) patients.Methods:From July 2019 to December 2020, a total of 120 elderly MHD patients admitted in the First Affiliated Hospital of Zhengzhou University were selected as the research objects, and divided into the experimental group and the control group with 60 cases in each group by random number table method. The control group conducted routine dietary management, and the experimental group received dietary management based on family participation. Six months after intervention, the dietary compliance attitude, dietary compliance behavior and nutritional status were compared between the two groups.Results:Six months after intervention, the scores of social restriction attitude, self-care attitude, acceptance attitude and dietary compliance behavior attitude of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The scores of fluid restriction behavior, potassium intake behavior, self-care compliance, compliance in the face of difficulties, and dietary compliance of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The serum prealbumin (PA) , albumin (ALB) , hemoglobin (Hb) , and transferrin (TRF) of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Diet management based on family participation can enhance the attitude of dietary compliance, promote the development of dietary compliance behavior, and improve the nutritional status of elderly patients with MHD.

Background: /Aim: We aimed to investigate the efficacy and safety of stereotactic body radiation therapy (SBRT) in elderly patients with small hepatocellular carcinomas (HCC). Methods: Eighty-three patients (89 lesions) with HCC who underwent SBRT between January 2012 and December 2018 were reviewed in this retrospective observational study. The key inclusion criteria were as follows: 1) age ≥75 years, 2) contraindications for hepatic resection or percutaneous ablative therapies, 3) no macroscopic vascular invasion, and 4) no extrahepatic metastasis. Results: The patients were 75-90 years of age, and 49 (59.0%) of them were male. Most patients (94.0%) had an Eastern Cooperative Oncology Group performance status of 0 or 1. Seventy-four patients (89.2%) had Child-Pugh class A hepatic function before SBRT. The median tumor size was 1.6 cm (range, 0.7-3.5). The overall median follow-up period was 34.8 months (range, 7.3-99.3). The 5-year local tumor control rate was 90.1%. The 3-year and 5-year overall survival rate was 57.1% and 40.7%, respectively. Acute toxicity grade ≥3 was observed in three patients (3.6%) with elevated serum hepatic enzymes; however, no patient experienced a worsening of the Child-Pugh score to ≥2 after SBRT. None of the patients developed late toxicity (grade ≥3). Conclusions SBRT is a safe treatment option with a high local control rate in elderly patients with small HCC who are not eligible for other curative treatments.

Fear memories are temporarily suppressed after repeated retrieval, a phenomenon known as memory extinction.How to reduce or even eliminate fear memory is the key to the treatment of fear related diseases such as post-traumatic stress disorder(PTSD). A single extinction training based on Pavlov's fear regulation task could only inhibit the expression of conditioned fear memory traces, but it could not eliminate the acquired conditioned fear memory. However, according to the reconsolidation theory based on memory, the retrieval-extinction paradigm has a more lasting effect on the erasure and rewriting of fear memory, and can effectively prevent the return of fear memory. Studies have shown that extraction-regression is closely related to a variety of neurotransmitter receptors such as glutamate receptor(GluR), dopamine receptor(DAR), L-type voltage-gated calcium channels(LVGCs) and cannabinoid. Moreover, its effect is closely related with factors such as retrieval-extinction memory stage. At present, most of the researches on extracted boundary conditions only stay at the level of behavior, with little understanding and exploration on the level of molecular mechanism. From the perspective of molecular neurobiology, with different stages of memory and different types of receptors and molecular mechanisms, this research reviewed the mechanisms of retrieval-extinction in recent years.It provided valuable signaling pathways, molecular targets and research directions for the treatment of fear-related diseases such as PTSD.

Background/Aims: Stereotactic body radiation therapy (SBRT) is used as an alternative ablative treatment in patients with hepatocellular carcinoma (HCC) not suitable for curative treatments. The purpose of this prospective study was to evaluate the long-term efficacy of SBRT for small (≤5 cm) HCCs. Methods: A phase II, single-arm clinical trial on SBRT for small HCCs was conducted at an academic tertiary care center. The planned SBRT dose was 45 Gy with a fraction size of 15-Gy over 3 consecutive days. The primary endpoint was 2-year local control rate. Radiologic responses were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) and the modified RECIST criteria. Results: Between 2013 and 2016, 50 patients (53 lesions) were enrolled, with a median follow-up period of 47.8 months (range, 2.9–70.6). Patients’ age ranged from 41 to 74 years, and 80% were male. Median tumor size was 1.3 cm (range, 0.7–3.1). The 2- and 5-year local control rates were 100% and 97.1%, respectively. The 5-year overall survival rate was 77.6%. Six months after SBRT, radiologic responses were evident in 44 lesions (83%) according to the RECIST criteria and 49 (92.4%) according to the modified RECIST criteria. None of the patients showed grade ≥3 adverse events. Conclusions SBRT showed excellent results as an ablative treatment for patients with small HCCs while showing minimal toxicities. SBRT can be a good alternative for both curative and salvage intents in patients with HCCs that are unsuitable for curative treatments.

Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae ( CRE) isolated from children in China. Methods CRE strains were collected in 10 ter-tiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method ( KB method) and automated method. The re-sults were analyzed according to the Clinical and Laboratory Standards Institute ( CLSI) Standards published in 2017. WHONET 5. 6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3065 CRE clinical strains were isolated from children with an overall prevalence of 7. 7％ and among them, 13. 5％ were isolated in neonatal group and 5. 8％ in non-neo-natal group. The detection rate of CRE in 2017 was higher than that in 2016 (9. 7％ vs 5. 7％). Among the 3065 CRE strains, there were 1912 strains of Klebsiella pneumoniae (62. 0％), 667 strains of Escherichia coli (22. 0％), 206 strains of Enterobacter cloacae (7. 0％), 56 strains of Klebsiella aerogenes (1. 8％) and 47 strains of Serratia marcescens (1. 5％). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44. 8％ and 19. 7％, respectively. Respiratory tract (61. 8％), urine (19. 4％) and blood (5. 7％) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79. 6％-100％), especially those isolated in the neonatal group (P<0. 05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19. 7％) and fos-fomycin (11. 9％), fluoroquinolones such as levofloxacin (37. 7％) and ciprofloxacin (43. 3％), and tige-cycline (3. 8％). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug re-sistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken.