Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Circulating tumor DNA(ctDNA)is a kind of cell-free DNA derived from tumors,which carries comprehensive tumor genetic information;Recent studies have found that ctDNA detection can play a role in the early diagnosis,targeted therapy,and prediction of recurrence in tumors.Human papillomavirus(HPV)-associated gynecological malignancies include most cervical cancer,some vulvar cancer,and vaginal cancer.High-risk HPV long-term infection and integration with cell genome are important causes of these cancers.Studies found that the use of ctDNA detection technology to dynamically monitor changes in HPV-ctDNA can provide valuable information for the clinical management and prognosis of these cancers.Thus,HPV-ctDNA is expected to become an biomarker for HPV-associated tumors.

Objective To investigate the relationship between serum L-carnitine and its related metabolites[trimethylamine(TMA)and trimethylamine N-oxide(TMAO)]levels and gestational diabetes mellitus(GDM)in the second trimester of pregnant women in Shanghai.Methods A case-control study was conducted in 280 pregnant women between 18 and 23 weeks of gestation from January 2018 to January 2021.Among them,134 cases of GDM were the case group(GDM),and 146 cases with normal blood glucose(BG)were the control group(Con).Serum L-carnitine,TMA and TMAO levels were quantified by ultra high performance liquid chromatography-mass spectrometry.Logistic regression analysis,stratified analysis and linear regression were used to explore the relationship between L-carnitine,TMA and TMAO levels and GDM and glucolipid metabolism.Results Serum L-carnitinelevelwas significantly lower in GDM group than that in Con group(P<0.01).After adjusting for confounders,logistic regression showed a 70%reduction in the risk of GDM in the group with highest tertile of L-carnitine compared with the group with lowest tertile(OR 0.30,95%CI 0.15～0.63).The risk of GDM decreased by 14%for each 1 μmol/L increase in serum L-carnitine(OR 0.86,95%CI 0.80～0.93).Serum L-carnitine was negatively correlated with 1 hPG(r=-0.21,P<0.01)and 2 hPG(r=-0.15,P<0.05),respectively,TMA was negatively correlated with 2 hPG(r=-0.21,P<0.01).Conclusions Higher serum L-carnitine level may be negatively associated with GDM.Serum L-carnitine and TMA levels were negatively correlated with blood glucose levels.

Objective:To analyze the effects of paroxetine combined with aniracetam on the treatment of senile depression and the levels of 5-hydroxytryptamine (5-HT), cortisol and cystatin C(CysC).Methods:A total of 80 patients admitted to the psychiatric Department of Psychiatry, Suzhou City Guangji Hospital from January 2020 to January 2023 were selected and divided into two groups by random number table method: control group (40 cases) and observation group (40 cases). The control group was treated with oral paroxetine hydrochloride tablets, and the observation group was treated with oral paroxetine hydrochloride combined with aniracetam tablets. Negative emotions were assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before and after treatment, and sleep quality was assessed by Pittsburgh Sleep Quality Scale (PSQI). Serum levels of central neurotransmitters [norepinephrine (NE) and 5-HT], neurotrophic factor (BDNF), oxidative stress [cortisol and malondialdehyde (MDA)] and amino acid metabolism [cysteine (Hcy) and CysC] were measured before and after treatment.Results:After treatment, SAS and SDS scores in both groups were significantly decreased (all P<0.05), and SAS and SDS scores in the observation group were significantly lower than those in the control group (all P<0.05). After treatment, the sleep quality, sleep time, sleep time, sleep efficiency, sleep disorders, hypnotic drugs, daytime function scores and PSQI total scores of the two groups were significantly decreased (all P<0.05), and the above scores of the observation group were significantly lower than those of the control group ( P<0.05). After treatment, the serum levels of NE, 5-HT and BDNF in 2 groups were significantly increased, and the serum levels of NE, 5-HT and BDNF in the observation group were significantly higher than those in control group (all P<0.05). After treatment, the levels of serum cortisol and MDA in both groups were significantly decreased, and the levels of serum cortisol and MDA in the observation group were significantly lower than those in the control group (all P<0.05). After treatment, the serum Hcy and CysC levels in 2 groups were significantly decreased, and the serum Hcy and CysC levels in the observation group were significantly lower than those in the control group (all P<0.05). Conclusions:Paroxetine combined with aniracetam is more effective than paroxetine alone in the treatment of senile depression, which can effectively relieve anxiety and depression symptoms, improve sleep quality, and have positive effects on serum neurotransmitters, neurotrophic factors, oxidative stress and amino acid metabolism levels of patients.

Objective:To analyze the risk factors of medical adhesive-related skin injury (MARSI) in preterm infants to establish a nomogram model to predict the risk of MARSI.Methods:From July to September 2018, 268 premature infants who were hospitalized in NICU were enrolled in this study. Their clinical data were analyzed and univariate analysis was used to detemine the risk factors related to MARSI, The significant variables were included in the multivariate logistic regression analysis to analyze the independent risk factors for MARSI. Then the R software was used to establish a predictive nomogram model, Bootstrap method was used to validate the nomogram model and the consistency test of the correction curve was used to explore the predictive efficacy of the model in predicting the MARSI.Results:A total of 64 cases out of 268 premature infants had MARSI. The prevalence rate was 23.9 % (64/268). Birth age (28 to 32 weeks) ( P value was 0.021, OR value was 2.736, 95 % CI 1.163-6.435), edema ( P<0.01, OR value was 33.782, 95 % CI 10.510-108.583), maternal diabetes ( P value was 0.039, OR value was 16.011, 95 % CI 1.146-223.692), easy to tear tape ( P value was 0.027, OR value was 13.567, 95 % CI 1.340-137.311) were all independent risk factors for MARSI. The nomogram model showed a conformance-index of 87.29 %, while the consistency test of the correction curve showed that the prediction probability is consistent with the actual occurrence probability. Conclusions:The nomogram built based on the indexes of fetal age, skin state, maternal disease, mucous product has good discrimination and accuracy which could be helpful for screening the patients with high risk, with potentially high clinical application value.

Objective To observe the effect of Huangqi granules combined with external treatment on the clinical therapeutic effects of typeⅡand Ⅲ stress injuries. Methods A total of 240 patients with typeⅡ andⅢ pressure injuries admitted to the Hengshui People's Hospital from January 2017 to March 2019 were enrolled. According to difference in therapeutic methods, the patients were divided into astragalus mongholicus granule group and routine treatment of Western medicine group, with 120 cases in each group. In both groups, the patients were given routine nursing treatment such as air cushion bed, regular body turn-over, nutrition support, health education, etc;in routine Western medicine treatment group, according to the principle of aseptic dressing change, the wounds were treated and covered with foam dressing; while in the astragalus mongholicus granule group, the routine nursing care and sterile dressing as above mentioned were also applied, additionally 3 bags of oral astragalus mongholicus granules mixed with boiled water each time, twice a day (equivalent to 10 g for each bag of Chinese herbal slices), 7 days as one course of treatment; at the same time, the wound was sterilized, debrided and washed with normal saline, and after drying, the rubber Shengji ointment for promoting growth of tissue was evenly spread on the wound and covered with foam dressing. In the two groups, the changes of pressure ulcer healing evaluation scale (PUSH) scores before treatment and 7, 14, 21 and 28 days after treatment, as well as the differences in wound healing time and clinical efficacy between the two groups after treatment were observed, and the recurrence rate was followed up for 10 weeks. Results Compared with routine Western medicine group, the Ⅱand Ⅲ wound healing times were significantly reduced in the astragalus mongholicus granule group [the days of wound healing for Ⅱ stress injury (days): 7.81±1.40 vs. 16.52±1.89, the days of wound healing for Ⅲ stress injury (days): 14.60±1.50 vs. 20.23±1.27, both P < 0.05]. With the prolongation of therapeutic time, the PUSH scores of two groups decreased gradually, there was no significant difference in the PUSH scores between the two groups before treatment and 7 days after treatment (both P > 0.05); after 14 days of treatment, the PUSH score of astragalus mongholicus granule group was significantly lower than that of the routine western medicine group (7.82±1.93 vs. 9.96±1.89), and lasted until 28 days (4.16±0.47 vs. 5.29±0.57), the differences being statistically significant (both P < 0.05). The total effective rate of the astragalus mongholicus granule group was significantly higher than that of the routine western medicine treatment group [99.41% (171/172) vs. 74.51% (114/153), P < 0.05], and the recurrence rate of the mongholicus granule group was obviously lower than the routine Western medicine treatment [3.60% (5/139) vs. 17.74% (11/62), P < 0.05]. Conclusion Oral astragalus mongholicus granules combined with myocreatic ointment external therapy can effectively shorten the healing time of type Ⅱand Ⅲ stress injury, improve the cure rate and reduce the recurrence rate.

Objective To assess the effects of cognitive-behavioral group psychotherapy on depression,anxiety and medication adherence in elderly patients with coronary heart disease.Methods Eighty patients from two communities in Qinghai province were randomly divided into intervention group (n=40) and control group (n=40).In addition to regular care for both groups,patients in the intervention group also received eognitive-behavioral group psychotherapy.Depression,anxiety and medication adherence were measured with the Zung Self-Rating Depression Scale (SDS),the Zung Self-Rating Anxiety Scale (SAS) and the eight-item Morisky Medication Adherence Scale (MMAS-8),respectively,at baseline,immediately after intervention,at 3 months after intervention,and at 6 months after intervention.Results The repeated-measures ANOVA showed that improvement in depression,anxiety and medication adherence before and after intervention in the intervention group was greater than in the control group (F =22.805,48.058,128.058,all P＜0.05).Scores for depression and anxiety were lower and scores for medication adherence were higher (all P＜0.05) in the intervention group than in the control group at all the time points after intervention.Conclusions Cognitive-behavioral group psychotherapy can alleviate depression and anxiety,and improve medication adherence in elderly patients with coronary heart disease.

Purpose To observe the shape of postnatal early female pelvic diaphragmatic hiatus and the mobility of lower urinary tract bladder neck with three-dimensional transperineal ultrasound,and to analyze the related parameters of postnatal early stress urinary incontinence (SUI) to screen SUI early after delivery and provide objective indices for pelvic floor rehabilitation.Materials and Methods 170 primiparae,including 13 cases of SUI group and 157 cases of asymptomatic group,were operated pelvic floor ultrasonic examination,human pelvic floor midsagittal sections and pelvic diaphragmatic hiatus rebuilding images were obtained,and such related biological parameters as bladder neck mobility and pelvic diaphragmatic hiatus indicators were determined.Results The incidence of SUI at 6-8 weeks after delivery was 4.55％,and that after vaginal delivery was 9.61％,the difference was not statistically significant (P＞0.05).The lower migration of the bladder neck (1.83±0.54) cm on Valsalva maneuver,and transverse diameter (421±0.73) cm,vertical diameter (5.89±0.97) cm and area (20.38±6.30) cm2 of pelvic diaphragmatic hiatus in SUI group were greater than those in the asymptomatic group (P＜0.05),and the difference between parameters of the two groups in resting state and anal shrinkage was of no statistical significance (P＞0.05).Conclusion The shape of urethra,lower migration of bladder neck and the parameters of pelvic diaphragmatic hiatus on Valsalva maneuver are sensitive indicators in ultrasonic evaluation of SUI,are conductive to screening of SUI after early delivery in combination with patient symptoms and can guide the high risk puerpera for early pelvic floor rehabilitation.

Objective To discuss theoretical structure model for the scale of recurrent oral ulcer (ROU) with traditional Chinese medicine characteristics; To lay a theoretical foundation for further developing scale. Methods This study followed international patients reported outcome (PRO) scale development specification, combined TCM theories, including the theory of mouth dominate and five internal organs correlation, uniformed spirit and body, correspondence between human and the universe, seven emotions, constructed theoretical structure of PRO scale of ROU. Results The theoretical structure of PRO scale of ROU included four major areas as physiology, psychology, independence, and society and nature. Conclusion Theoretical model of PRO scale of ROU laies the foundation and provides the oretical guidance for the formulation of PRO scale of the ROU.

Through the construction practice of the optic nerve disease picture database,the paper discusses the system architecture,database field,data content,picture processing,organization and implementation,and other issues about the construction of the clinical case picture database,states and analyzes the operation effect,points out deficiencies,and provides reference for the construction of relevant picture databases.