Objectives:To evaluate the efficacy and safety of adalimumab (ADA) biosimilar in the treatment of Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. The patients with CD treated with ADA biosimilar in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to March 2022 with complete data were enrolled. The disease activity of patients at baseline was evaluated by Harvey-Bradshaw index (HBI) . The patients were divided into active group and remission group according to the activity. The primary endpoints were clinical response rate and remission rate at the 12th week in patients with active CD. The secondary endpoints included the clinical response rate and the remission rate in patients with active CD at the 26th week, maintenance remission rate at the 12th and the 26th weeks in patients with remission CD, and safety report.Results:Forty-eight patients were included. There were 20 patients whose HBI was 7 (6, 8) points in active group and 28 whose HBI was 3 (2, 4) points in remission group. In patients with active CD, the clinical response rate was 70.0% (14/20) and clinical remission rate was 60.0% (12/20) at the 12th week. The clinical response rate and clinical remission rate were both 61.5% (8/13) at the 26th week. The maintain remission rate of patients with remission CD was 96.4% (27/28) and 92.3% (12/13) at the 12th and the 26th weeks respectively. During the follow-up period, adverse reactions occurred in 2 patients (4.2%) and no serious adverse reaction was found.Conclusion:ADA biosimilar has good efficacy and safety in short-term induction and maintenance of clinical remission in Chinese patients with mild to moderate active CD.

Objectives:To evaluate the efficacy and safety of adalimumab (ADA) biosimilar in the treatment of Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. The patients with CD treated with ADA biosimilar in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to March 2022 with complete data were enrolled. The disease activity of patients at baseline was evaluated by Harvey-Bradshaw index (HBI) . The patients were divided into active group and remission group according to the activity. The primary endpoints were clinical response rate and remission rate at the 12th week in patients with active CD. The secondary endpoints included the clinical response rate and the remission rate in patients with active CD at the 26th week, maintenance remission rate at the 12th and the 26th weeks in patients with remission CD, and safety report.Results:Forty-eight patients were included. There were 20 patients whose HBI was 7 (6, 8) points in active group and 28 whose HBI was 3 (2, 4) points in remission group. In patients with active CD, the clinical response rate was 70.0% (14/20) and clinical remission rate was 60.0% (12/20) at the 12th week. The clinical response rate and clinical remission rate were both 61.5% (8/13) at the 26th week. The maintain remission rate of patients with remission CD was 96.4% (27/28) and 92.3% (12/13) at the 12th and the 26th weeks respectively. During the follow-up period, adverse reactions occurred in 2 patients (4.2%) and no serious adverse reaction was found.Conclusion:ADA biosimilar has good efficacy and safety in short-term induction and maintenance of clinical remission in Chinese patients with mild to moderate active CD.

Objective:Serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is a useful biomarker of bacterial infection. However, the diagnostic value of sTREM-1 of alveolar fluid in pulmonary infection is still unclear. This article aimed to explore the value of sTREM-1 of alveolar fluid in the early diagnosis of ventilator-associated pneumonia (VAP) by systematic review of relevant literatures.Methods:CNKI, Wanfang, VIP, PubMed/Medline and Embase databases were retrieved. Articles on diagnosis of VAP by sTREM-1 before June 30, 2019 were collected. QUADAS-2 scale provided by Cochrane Collaboration Network was used to evaluate the quality of diagnostic experiments. RevMan 5.3 and Stata 13.0 software were used to complete Meta-analysis. The levels of sTREM-1 between VAP and non-VAP patients were analyzed by Meta-analysis, and then diagnostic test Meta-analysis was conducted. Heterogeneity, sensitivity and publication bias were analyzed.Results:A total of 24 articles were enrolled. QUADAS-2 scale indicated that the selected literature had low bias and high clinical adaptability. ① In Meta-analysis of sTREM-1 level in alveolar fluid, 20 articles were selected and found to have high heterogeneity ( I2 = 94.4%, P = 0.000). The random effects models were used for Meta-analysis. It was indicated that the sTREM-1 level in alveolar fluid of VAP group was significantly higher than that of non-VAP group with significant difference [standardized mean difference ( SMD) was 1.47, 95% confidence interval (95% CI) was 1.00-1.95, Z = 6.14, P = 0.000]. By subgroup analysis and Meta-regression analysis, no source of heterogeneity was found. Sensitivity analysis suggested that the results of this Meta-analysis were robust and credible, and Begg funnel plot analysis showed that there was no significant publication bias ( Z = 1.46, P = 0.143). ② A total of 18 articles were included in the Meta-analysis of diagnostic experiments. Deek funnel plot showed publication bias ( P = 0.012). The combined sensitivity was 0.87 (95% CI was 0.81-0.91), specificity was 0.80 (95% CI was 0.73-0.86), and diagnostic odds ratio ( DOR) was 26 (95% CI was 13-50). Subgroup analysis of three different sources of alveolar fluid (bronchoalveolar lavage fluid, endotracheal aspiration fluid and exhaled ventilator condensate) showed that STREM-1 had a certain value in early diagnosis of VAP. The I2 of combined DOR was 35.4%, and I2 of sensitivity was 79.46%, I2 of specificity was 77.61%, suggesting heterogeneity in the selected literature. Subgroup analysis found that nationality, subject design, sample source, sample size and diagnostic "gold criteria" were related to heterogeneity, but not age. The area under synthetic receiver operating characteristic (SROC) curve (AUC) was 0.90 (95% CI was 0.87-0.92). Conclusions:The detection of sTREM-1 level in alveolar fluid can be used for the early diagnosis of VAP with high sensitivity and specificity. If combined with other biomarkers, it may have more diagnostic value.

Objective: To describe the dermoscopic features of extramammary Paget′s disease (EMPD) and chronic eczema of the vulva, and to explore the value of dermoscopy in the diagnosis and differential diagnosis of the above diseases. Methods: Dermoscopic images were collected from 20 patients with histopathologically confirmed vulvar EMPD and 16 patients with clinically confirmed chronic eczema of the vulva in Hospital for Skin Diseases, Chinese Academy of Medical Sciences and Pekin Union Medical College from January 2017 to April 2018, and retrospectively analyzed. Fisher′s exact test was used to compare the prevalence of dermoscopic features between the two groups. Results: As dermoscopy showed, the milky red background was observed in 19 EMPD patients and in only 1 patient with chronic eczema, and there was a significant difference in the prevalence of milky red background between the two groups (P < 0.001) . White scales were the most common desquamation, and were observed in 9 EMPD patients and 13 patients with chronic eczema (P = 0.128) . Blood vessels were uniformly distributed in EMPD patients, including dotted-globular vessels in 19 and linear vessels in 14, while blood vessels were distributed in a patchy or clustered pattern in the patients with chronic eczema, including dotted-globular vessels in 16 and linear vessels in 7. There was a significant difference in the prevalence of different distribution patterns of blood vessels between the two groups (P < 0.001) . Bright white streaks, bright white structureless area and reticular structure were observed in 19, 20 and 19 EMPD patients respectively, and in 1, 1 and 1 patient with chronic eczema respectively, and there were significant differences in the prevalence of the above 3 structures between the two diseases (all P < 0.001) . Conclusion Vulvar EMPD and chronic eczema both show characteristic dermoscopic features, and dermoscopy is of great value to the diagnosis and differential diagnosis of EMPD.

Objective To identify primary gout biomarkers. Methods Isobaric tags for relative and absolute quantitation (iTRAQ) technique combined with liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to screen differentially expressed proteins, and to identify potential biomarkers by analysis of the biological process, cellular components, molecular functions, KEGG pathways and protein-protein interactions. Difference between two groups were measured byt test. Results We identified 95 differentially expressed proteins (50 up-regulated proteins and 45 down-regulated proteins, respectively), and 20 significant KEGG pathways. Among them, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), α-enolase (ENOA), phosphoglycerate kinase (PGK1), glucose-6-phosphate isomerase (G6PI) and moesin might play a role in the pathogenesis of primary gout. Conclusion iTRAQ technology can detect differentially expressed proteins from proteome, provides a strong theoretical basis for the study of biomarkers and evidence for the mechanisms in primary gout. However, further studies are needed.

Objective To study how to shorten the time of preoperative fasting and forbidding drink in clinical practice and the clinical application of its reconstructed process.Methods A total of 226 elective surgery patients,from the Department of Surgical Oncology of the First Affiliated Hospital of Wenzhou Medical University from November 1st,2015 to November 20th,2015 and from December 10th,2015 to December 30th, 2015,were selected by convenient sampling method as the research object. They were divided into the control group (n=117) and the experimental group (n=109) by using the before-and-after study method. In the control group,traditional preoperative fasting and forbidding drink process was adopted. In the experimental group,the new reconstructed preoperative fasting and forbidding drink process was adopted. The actual time of preoperative fasting and forbidding drink and the incidence of preoperative related adverse events were compared between two groups.Results The actual time of preoperative fasting was (7.60±0.98) h in the experimental group,which was significantly shorter than that in the control group (14.48±5.08)h(t=13.849,P<0.01). The actual time of preoperative forbidding drink was (3.39±0.97) h in the experimental group,which was significantly shorter than that in the control group (11.47±4.99)h(t=19.545,P<0.01). In the experimental group,the total incidence of adverse responses such as thirst and hunger before operation was 14.7%(16/109),which was significantly lower compared to the control group 35.9%(42/117)(χ2=13.317,P<0.01). There was no intraoperative aspiration in both groups.Conclusions The standard implementation of the new preoperative fasting and forbidding drink process can effectively shorten the preoperative fasting and forbidding drink time and improve the preoperative discomfort of elective surgery patients.

Objective To investigate and improve the occupational environment of nursing staff in tertiary hospitals.Methods By using questionnaire on nurse′s occupational environment carried out by nursing center of National Institute of Health Planning Hospital Management, 672 nurses from a tertiary hospital in Guangxi were investigated without signature online on the national nursing quality data platform.Results The total score of occupational environment of 672 nurses was (69.85±20.73). Among all the items, the score of training plan for new nurses got a relatively high score (87.02±18.79); the score of clear occupational exposure process within hospital and its implementation was (84.57±19.91); and the items got low score included the chance of nurses to participate in hospital management decision (50.84±31.93) and an appropriate system of salary allotment (53.53±31.84). The scores of nurses with different educational background,working seniorities, professional titles and weather be enlisted were statistically significant (P<0.05).Conclusions It is significant for the safety of patients and development of nursing department to establish a system which includes providing the chance for nurses to participate in hospital management, improving salary of nurses, emphasizing the development of nursing specialty and building a harmoniously occupational environment.

OBJECTIVETo provide evidence for the prevention and treatment of occupational diseases by the analysis of existing major occupational hazards and health conditions of workers in a large shipbuilding factory.

METHODSField investigation of occupational conditions was conducted to examine the existence of occupational hazards from 2009 to 2012 in a large shipbuilding factory, and then the results of physical examination among its workers were analyzed.

RESULTSOther than the metal dust (total dust), the levels of other dusts and manganese dioxide were beyond the national standard to various degrees, and through a sampling point detection, it was found that the levels of manganese dioxide exceeded the standard by 42.8%. The maximum time-weighted average concentration in individuals was 27.927 mg/m(3), much higher than the national standard limit. For harmful gas detection in individuals, xylene was 38.4%above the standard level (the highest concentration reached 1447.7 mg/m(3)); moreover, both toluene and ethylbenzene exceeded the national standard at different levels. Among the noise-exposed workers, 71%worked in the environment where the daily noise was above the limit of the national standard (85 dB). Physical examinations in 2010 and 2012 showed that the abnormal rate of audiometry in workers was higher than 15%.

CONCLUSIONDust (total dust), manganese dioxide, benzene, and noise are the main occupational hazards among the workers in the large shipbuilding factory, and strict protection and control for these hazards should be implemented for the workers in the factory.

Air Pollutants, Occupational ; analysis ; Construction Industry ; Dust ; analysis ; Environmental Monitoring ; Humans ; Noise, Occupational ; Occupational Diseases ; epidemiology ; Occupational Exposure ; analysis ; Ships

Objective To explore the methods for training the abitity of critical thinking of ICU nurses.Methods ICU nurses were trained in terms of knowledge training, case study, care rounds, self-reflection, case discussion, simulation training and seminars. The Chinese version of the critical thinking disposition inventory(CTDI-CV)was used before and one year after the training.Result The scores on CTDI-CV as well as the items after training were all significantly higher than that before training(P<0.05).Conclusion The knowledge and ability in critical thinking can be improved by knowledge and skills training.

Objective To evaluate the efficacy and safety of triethanolamine cream in the treatment of skin ulcer. MethodsA multicenter,single-blind,randomized,positive-control study was conducted.One-hundred and twenty patients aging 18-65 years with skin ulcer were randomly classified into the test and control group at a ratio of 2 ∶ 1 to be treated with triethanolamine cream and recombinant bovine basic fibroblast growth factor gel respectively for 4 weeks.The healing rate of ulcer,granulation tissue production rate and epithelialization rate were calculated.Results After the beginning of treatment,the condition of all patients was improved with time.In total,76 out of 80 triethanolamine-treated patients and 38 out of 40 basic fibroblast growth factor gel-treated patients completed the 4-week trial.Significant differences were observed in the healing rate of ulcer,epithelialization rate and granulation tissue production rate between the test and control group (71.05％ vs.34.21％,P =0.0002; 85％ vs.50％,P =0.0001; 66.25％ vs.37.5％,P =0.0035).No adverse events occurred in any of the patients.Conclusions Triethanolamine cream seems superior to recombinant bovine basic fibroblast growth factor gel with regard to the healing rate of ulcer,epithelialization rate and granulation tissue production rate,and may be a promising drug for the treatment of skin ulcer.