ObjectiveTo analyze the factors influencing meropenem-related liver injury （MRLI） and to explore their clinical predictive value. MethodsA retrospective case-control study was conducted， and the Chinese Hospital Pharmacovigilance System （CHPS） was used to establish a retrieval scheme. A total of 1 625 hospitalized cases using meropenem from January 2018 to December 2022 were collected. Patients were divided into case group （n=62） and control group （n=1 563） based on the presence or absence of liver injury. Clinical data and laboratory indicators from both groups were collected and analyzed. The t-test was used for comparison of normally distributed continuous data between the two groups， while the Mann-Whitney U test was used for comparison of continuous data not conforming to a normal distribution. The chi-square test was used for comparison of categorical data between the two groups. A multivariate Logistic regression analysis was performed to identify the influencing factors for MRLI. A Logistic regression equation was established， and the predictive value of these factors was assessed using the receiver operating characteristic （ROC） curve. ResultsThe results of univariate analysis indicated that the rates of male patients， hypoproteinemia， shock， intensive care unit （ICU） admissions， sepsis， and liver， gallbladder， and cardiovascular diseases， the levels of alanine aminotransferase （ALT）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， aspartate aminotransferase （AST）， creatinine （CREA）， and procalcitonin （PCT）， and the number of hospitalization days were significantly higher in the case group than in the control group （P<0.05）， and that the platelet levels in the case group were significantly lower than those in the control group （P<0.05）. The multivariate Logistic regression analysis showed that male sex （odds ratio ［OR］=2.080， 95% confidence interval ［CI］： 1.050 — 4.123， P=0.036）， admission to the ICU （OR=8.207， 95%CI： 4.094‍ ‍—‍ ‍16.453， P<0.001）， comorbidity with gallbladder disease （OR=8.240， 95%CI： 3.605‍ ‍—‍ ‍18.832， P<0.001）， ALP （OR=1.012， 95%CI： 1.004‍ ‍—‍ ‍1.019， P=0.004）， GGT （OR=1.010， 95%CI： 1.005‍ ‍—‍ ‍1.015， P<0.001）， and PLT （OR=0.997， 95%CI： 0.994‍ ‍—‍ ‍0.999， P=0.020） were the influential factors for MRLI. The areas under the ROC curve of ALP， GGT， and PLT were 0.589， 0.637， and 0.595， respectively， and the AUC of them combined was 0.837. ConclusionMale sex， ICU admission， comorbidity with gallbladder disease， increased ALP， increased GGT， and decreased PLT were influencing factors for MRLI， and a combination of factors has a better predictive value for the occurrence of MRLI.

Objective To explore the safety and efficacy of ultrasound-guided minimally invasive(16 F)partial tubeless percutaneous nephrolithotomy(PCNL)in the treatment of renal and ureteral upper calculus with high-risk factors.Methods 29 patients with renal or/and ureteral upper calculus with high-risk factors from May 2021 to Mar 2024 were retrospectively analyzed.Among them,there were 6 cases of cardiac insufficiency,10 cases of pulmonary insufficiency,10 cases of renal insufficiency,10 cases of hypertension,5 cases of diabetes,1 case of postoperative difficult airway of laryngeal cancer,and 7 cases of cerebrovascular and neuropathy.All the patients underwent PCNL with 16 F microchannel under the ultrasound-guided after local anesthesia,and the ureteral stent was routinely placed after surgery without insetting nephrostomy tube,that was,partial tubeless PCNL.Results All the patients completed the operation,of which 6 patients due to infection and renal dysfunction,first under local anesthesia ultra-microstomy(F 6 single J tube)drainage.PCNL was performed after the condition was stabilized.The operative time was 30～94 min,with an average of(55.8±16.7)min.The intraoperative visual analogue scale(VAS)was 3～6,with an average of(4.2±0.9).The postoperative hemoglobin decreased by 1～26 g/L,with an average of(8.4±6.6)g/L,and the postoperative VAS was 2～7,with an average of(3.2±1.2).The stone-free rate was 82.8％(24/29)by abdominal CT examination 2 to 3 days after surgery.1 case underwent flexible ureteroscopy under local anesthesia in 3 weeks,2 cases underwent extracorporeal shock wave lithotripsy,and 2 cases underwent drug lithotripsy due to renal multiple small calculi.1 case underwent blood transfusion and renal artery embolization due to arteriovenous fistula,no open surgery occurred,and no complications such as pleural injury.Conclusion Local anesthesia partial tubeless PCNL by ultrasound-guided for the treatment of high-risk renal or/and ureteral calculus has the advantages of low anesthesia risk,fewer complications,rapid recovery,and satisfactory surgical results,and can be used as a surgical method for such patients.

Objective To investigate the potential categories of exercise perception in patients with end-stage renal disease(ESRD),and analyze the relationship between different latent categories and change in physical activity,so as to provide references for targeted intervention.The latent profile analysis was used to extract potential categories of exercise perception,and multiple linear regression analysis was conducted with potential categories as independent variables and change in physical activity as dependent variables.Methods A total of 265 ESRD patients from a tertiary hospital were selected from June 2022 to May 2023 by convenience sampling method.The general data questionnaire,the Dialysis Patient-perceived Exercise Benefits and Barriers Scale(DPEBBS)and the Measuring Change in Physical Activity Questionnaire(MCPAQ)were used for investigation.Results A total of 241 ESRD patients completed the survey.The results of multiple linear regression analysis showed that education level,family per capita monthly income and potential categories of exercise perception were the influencing factors of change in physical activity in ESRD patients(P＜0.05).Conclusion There was group heterogeneity in the exercise perception in patients with ESRD.Clinical workers should give targeted intervention according to the potential categories of patients'exercise perception,so as to promote the initiation and long-term maintenance of the change in physical activity.

Objective:This study aims to investigate the expression levels of α-synuclein(α-synuclein)and apolipoprotein A-1(ApoA1)in elderly patients with cerebral small vessel disease(CSVD)and their association with cognitive function.Methods:A total of 176 elderly patients diagnosed with CSVD and admitted to Huludao Central Hospital between September 2022 and February 2024 were retrospectively selected as research subjects.Based on their cognitive function at the time of admission, patients were categorized into a disorder group comprising 71 cases and a normal group consisting of 105 cases.General information was collected from the patients, and the serum expression levels of α-synuclein and ApoA1 were measured.Pearson correlation analysis was employed to assess the relationship between the expression levels of α-synuclein and ApoA1 and the Montreal Cognitive Assessment(MoCA)scores.Furthermore, multi-factor logistic regression analysis was conducted to identify influencing factors, and receiver operating characteristic(ROC)curves were generated to evaluate the diagnostic value of serum levels.Results:Patients in the disorder group were older than those in the normal group.Additionally, the MoCA score and serum α-synuclein levels were significantly higher in the disorder group, while ApoA1 levels were lower(all P<0.05).Pearson correlation analysis indicated that the MoCA score was negatively correlated with α-synuclein expression and positively correlated with ApoA1 expression(all P<0.05).Multivariate logistic regression analysis revealed that age, smoking history, and α-synuclein levels are risk factors for cognitive dysfunction in patients with CSVD, whereas ApoA1 is identified as a protective factor for cognitive function in this population.Furthermore, ROC curve analysis demonstrated that serum α-synuclein and ApoA1 levels possess diagnostic value for cognitive dysfunction in patients.The area under the curve(AUC)for the combined predictions was 0.836, with sensitivity and specificity rates of 76.14% and 78.14%, respectively. Conclusions:Elderly patients with CSVD and cognitive dysfunction exhibit abnormally high levels of α-synuclein and abnormally low levels of ApoA1.Both factors are influential in the context of cognitive dysfunction among elderly patients with CSVD and contribute to improved diagnostic efficiency.

Objective To analyze the very high frequency(VHF)ultrasound features of mixed tumor of the skin(MTS),and to explore the diagnostic value of VHF ultrasound features for MTS.Methods A total of 63 cases of MTS confirmed by surgery and pathology in the Department of Dermatology of Hangzhou Third People's Hospital from January 2019 to March 2024 were selected as observation group,and 63 other benign skin tumors in the same period were used as control group.The VHF ultrasound features of MTS were retrospectively analyzed and summarized,and the diagnostic efficiency of VHF ultrasound features for MTS was evaluated.Results Compared with other benign skin tumors,there were no significant differences in the length diameter,transverse diameter,aspect ratio,presence or absence of calcification,cystic disease,blood flow grade and resistance index between two groups(P＞0.05).However,MTS had a more obvious pseudo-capsule,and most of the internal echoes were not uniform,and the posterior side was accompanied by a enhancing effect,and the blood flow was dominated by marginal blood flow,and the difference between two groups was obvious(P＜0.05).The receiver operating characteristic curve showed that the combination of pseudo capsule,internal echo,marginal flow and peripheral enhancement had the highest diagnostic efficacy,with an area under the curve of 0.772,a sensitivity of 77.8％ ,and a specificity of 71.4％ .Conclusion MTS have specific VHF ultrasound features,which can provide more assistance in the clinical diagnosis of MTS.

Objective:To explore the development trajectory and influencing factors of self compassion in elderly patients with first stroke hemiplegia, in order to provide a theoretical basis for adopting more targeted intervention measures at different stages and early identification of elderly stroke hemiplegia patients with sustained low self compassion.Methods:This was a prospective longitudinal study. Convenience sampling method was used to select 247 elderly patients with first-episode stroke admitted to Sanya Central Hospital (Hainan Third People′s Hospital) from January to December 2022 and who were assessed as semi-disabled (Barthel index was 40-99 ) before discharge. The baseline data of patients were collected by general information questionnaire, self-compassion scale, simplified fear of disease progression scale and social support rating scale. The self-compassion level of patients was evaluated before discharge, 1 month after discharge, 3 months after discharge and 6 months after discharge.The latent class growth model (LCGM) was used to identify the development trajectory of self-compassion, and multivariate Logistic regression was used to analyze the predictors of different development trajectory categories.Results:Ultimately, 219 patients completed the entire investigation and follow-up. There were 132 males and 87 females, aged (69.74 ± 4.05) years old. The self-compassion level of patients before discharge, 1 month after discharge, 3 months after discharge and 6 months after discharge were (72.37 ± 11.53), (74.65 ± 13.26), (76.84 ± 12.11), (79.45 ± 13.64) points, and there were positive correlation between scores ( r values were 0.29-0.55, all P<0.05). Three different trajectory change categories were identified by LCGM, namely high-level stable group (29%,63/219), low-level delayed decline group (23%, 51/219), and medium-level elevated group (48%, 105/219).Multivariate Logistic regression analysis showed that per capita monthly income<2 000 yuan ( OR=2.857, 95% CI 1.093-7.464, P<0.05), high comorbidities ( OR=5.625, 95% CI 1.971-16.051, P<0.01), high fear of disease progression ( OR=1.167, 95% CI 1.080-1.261, P<0.01), and low social support ( OR=00.763, 95% CI 0.595-0.979, P<0.05) were more likely to enter the low-level delayed decline group, and high school education( OR=4.429, 95% CI 1.479-13.265, P<0.01) and high social support ( OR=1.120, 95% CI 1.043-1.202, P<0.01) were more likely to enter the middle-level rise group. Conclusions:The development trend of self-compassion in elderly stroke patients with semi-disability can be divided into three different trajectories: high-level stable group, low-level delayed decline group and medium-level elevated group. Low income level, more comorbidities and fear of disease progression are not conducive to the development of self-compassion after discharge, while high education level and social support are conducive to the improvement of self-compassion after discharge. Medical staff can formulate targeted intervention programs to improve patients′ self-compassion based on the above influencing factors.

Objective:To analyze the safety of reduced clinical target volume (CTV) irradiation of suspicious positive lymph nodes in IIa region in patients with N 0-N 1 nasopharyngeal carcinoma (NPC) and the protective effect of submandibular gland and long-term resting dry mouth, and to explore the diagnostic value of multimodal imaging for suspicious cervical lymph nodes. Methods:Clinical data of T 0-4N 0-1M 0 stage NPC patients admitted to Jiangsu Cancer Hospital from July 2015 to April 2017 were retrospectively analyzed. Clinical, radiation therapy planning, multimodal imaging and other relevant data were collected. All patients were treated with an optimized regimen of IMRT with a prophylactic radiation dose of 50.4 Gy (named as CTV50) for IIa region. Imaging characteristics and treatment response of suspicious lymph nodes were monitored by MRI, MRI-DWI, PET-CT and repeated enhanced positioning CT, etc. The dosimetry of the submandibular gland between optimized and standard dose plans (CTV50 vs. CTV60) was compared by paired t-test. The long-term dry mouth degree of the patients was evaluated using advanced radiation injury from Radiation Therapy Oncology Group (RTOG), Jiangsu Cancer Hospital Multi-dimensional Dry Mouth Evaluation Scale and summated xerostomia inventory (SXI). The difference of dry mouth degree was analyzed by rank-sum test. Results:A total of 106 patients were included in this study, including 149 cervical lymph node negative sides, 73 sides of which had ≤3 recognizable lymph nodes, and 76 of which were>3 in Ⅱa region. Among patients with N 1 stage, 63 patients underwent contralateral single neck area optimization, and 43 patients (N 0 stage and N 1 stage patients with retropharyngeal lymph node metastasis) underwent double-neck area optimization. A total of 109 suspicious lymph nodes with a short diameter of >5 mm were found on the largest cross section, of which 105 had clear portal structure. The ratio of long to short diameter was ≥1.5 in 93 cases, and the maximum standardized uptake value (SUV max) in PET-CT was ≥2.5 in 76 cases. No lymph node recurrence was found in the CTV optimized area. There was no significant difference in the average dose of GTV in tumor target area after optimization ( P>0.05), and the D mean and V 39 Gy in submandibular gland were significantly lower than those in unoptimized plan (both P<0.01). There was no significant difference in long-term dry mouth and resting dry mouth between patients with unilateral and bilateral optimization of submandibular gland (both P>0.05). Conclusions:The optimal program of CTV50 reduction irradiation in Ⅱa area of N 0-N 1 NPC patients is safe and effective. The submandibular gland has obvious dosimetric advantages, and patients have a good subjective response to resting dry mouth. The multimodal imaging tools such as enhanced CT, MRI-DWI and PET-CT should be performed to deliver individual evaluation and treatment for suspicious lymph nodes.

Objective:To investigate the treatment strategy and prognostic factors of nasopharyngeal necrosis after the first radical radiotherapy for nasopharyngeal carcinoma.Methods:Clinical data of 1020 patients with nasopharyngeal carcinoma undergoing radical intensity-modulated radiotherapy in Jiangsu Cancer Hospital from January 2013 to January 2022 were retrospectively analyzed. Nasopharyngeal necrosis was confirmed by nasopharyngeal MRI, electronic nasopharyngoscopy and biopsy. Patients with nasopharyngeal necrosis were treated with electronic nasopharyngoscope irrigation debridement, combined with systemic anti-infection and nutritional support therapy. Kaplan-Meier method was used to calculate the survival, and Cox regression analysis was used to analyze the relationship between clinical factors and patients' survival.Results:Nasopharyngeal necrosis occurred in 20 cases of 1020 nasopharyngeal carcinoma patients after the first radical intensity-modulated radiotherapy, with an incidence rate of 1.96%. Odd smell and headache were common in nasopharyngeal necrosis patients. All patients had locally advanced nasopharyngeal carcinoma at initial treatment, including 2 (10%) cases of T 3 stage and 18 (90%) cases of T 4 stage. Nasopharyngeal necrosis occurred in the primary nasopharyngeal lesions. According to the stages of nasopharyngeal necrosis, there were 6 (30%) cases of stage I, 14 (70%) cases of stage II and no stage III. The occurrence time of nasopharyngeal necrosis was from 2 to 24 months after radiotherapy, and the median time was 5 months. All 16 cases of nasopharyngeal necrosis were cured clinically after debridement and irrigation under nasopharyngoscope, systemic anti-infection and symptomatic support treatment. Among them, 9 cases had no necrotic cavity and complete healing and 7 cases had residual necrotic cavity. Four patients died of massive nasopharyngeal hemorrhage or due to the inability to nasopharyngeal irrigation. The 5-year survival rates were 37.5% and 85.7% in patients with and without internal carotid artery involvement ( P=0.008), and 25.0% and 77.8% in patients with and without diabetes mellitus ( P=0.016). Univariate Cox regression analysis showed that necrotic lesions involving internal carotid artery ( HR=5.80, 95% CI=1.14-29.38, P=0.034) and diabetes mellitus ( HR=10.24, 95% CI=1.19-88.04, P=0.034) were the influencing factors of overall survival. Conclusions:Nasopharyngoscope irrigation debridement combined with anti-inflammation and nutritional support treatment are effective interventions for nasopharyngeal necrosis after the first radical intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma. The necrosis involving the internal carotid artery and diabetes mellitus are important factors affecting the survival of patients. Vascular invasion caused by vascular rupture is the main cause of death.

Objective: To understand sleep quarity among primary and middle school students in Shenzhen City, so as to provide data support for sleeping quality improvement. Methods: A survey was conducted among 8 742 children selected from two 12 year schools in Longhua District of Shenzhen City, by purposive sampling method from December 22, 2020 to January 15, 2021. The general information was investigated with the self designed questionnaire, and sleep disturbance was investigated and evaluated with the Sleep Disturbance Scale for Children (SDSC). And Chi square test was applied for data analysis. Results: About 47.61 % of primary and middle school students in Shenzhen City reported sleep disturbance, 10.84% of students had moderate to severe sleep disturbance. The overall rate of sleep disturbance and moderate and to severe sleep disturbance among primary school students (48.03%, 10.04%), junior middle schools (45.89%, 11.30%), senior middle schools (52.61%, 16.83%) were found of statistically significant differences ( χ 2=8.89, 27.05, P <0.05). The time to fall asleep for primary school students, junior school students and senior school students at night during the study period were 22:00-23:00 (90.35%), 22:00-23:00 (62.37%), and 23:00-01:00 (61.44%), respectively, and the time to fall asleep of the different stages students were found of statistically significant differences ( χ 2=1 470.17, P <0.01). About 41.04% of students could fall asleep within 15 minutes and 50.57% could fall asleep within 15 to 30 minutes, and the differences in the latency for different stages students to fall asleep at night were of statistical significance ( χ 2=82.92, P <0.01); 8.03% of primary and middle school students had a night sleep time of over 9 hours, and 45.97 % had a night sleep time of 8-9 hours, and the differences in the night sleep time among different stages students were of statistical significance ( χ 2=1 292.86, P <0.01). Conclusions The main sleep problems among primary and secondary school students in Shenzhen City are insufficient sleep and poor sleep quality. The relevant departments should emphasize the sleep health education among children and their parents, so as to improve their sleep quality.

BACKGROUND:Jaws are most vulnerable to osteoporosis.Adipose-derived mesenchymal stem cells and bone morphogenetic protein 2 have the effect of promoting bone regeneration in osteoporosis.However,the repair effect of bone morphogenetic protein 2 modified adipose-derived mesenchymal stem cells on alveolar bone defects in osteoporosis is rarely reported. OBJECTIVE:To explore the repair effect of adipose-derived mesenchymal stem cells overexpressing bone morphogenetic protein 2 on alveolar bone defects in osteoporosis rats. METHODS:(1)The rat adipose-derived mesenchymal stem cells were infected with lentivirus overexpressing bone morphogenetic protein 2 gene,and identified by detecting the expression of green fluorescent protein and bone morphogenetic protein 2.(2)Osteoporosis rat model was established by ovariectomy.A 3 mm×3 mm×3 mm cylindrical defect was prepared at the first molar position on both sides of the upper jaw.(3)Gelatin sponge was implanted in rats of the sham operation group and osteoporosis group.In the adipose-derived stem cell group,the adipose-derived mesenchymal stem cells infected with empty vector lentivirus and gelatin sponge complex were implanted.In the adipose-derived mesenchymal mesenchymal stem cell group overexpressing bone morphogenetic protein 2,a complex of adipose-derived mesenchymal stem cells overexpressing bone morphogenetic protein 2 and gelatin sponge was implanted.Relevant indexes were tested one month later. RESULTS AND CONCLUSION:(1)The transfection efficiency of the adipose-derived mesenchymal stem cell group and adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein 2 reached more than 70%.Compared with the adipose-derived mesenchymal stem cell group,the level of bone morphogenetic protein-2 protein in the adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein-2 was significantly higher(P<0.05).(2)A large amount of new bone could be seen in the bone defect area of the sham operation group.Compared with the sham operation group,the osteoporotic group had a small amount of new bone formation;the new bone area was significantly reduced,and alkaline phosphatase,osteocalcin,and bone morphogenetic protein 2 mRNA and protein levels were significantly reduced.Compared with the osteoporosis group,the adipose-derived mesenchymal stem cell group and the adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein 2 had a large number of new bone formation;the area of new bone was significantly increased,and the levels of alkaline phosphatase,osteocalcin,and bone morphogenetic protein 2 mRNA and protein were significantly increased.Moreover,the adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein 2 was superior to the adipose-derived mesenchymal stem cell group(all P<0.05).(3)The results showed that bone morphogenetic protein 2 was less expressed in the alveolar bone of osteoporosis rats,and adipose-derived mesenchymal stem cells overexpressing bone morphogenetic protein 2 could promote osteogenesis and regeneration of alveolar bone defects in osteoporosis rats.