ObjectiveTo investigate the significance of different non-treatment thresholds or upper limits of normal （ULN） of alanine aminotransferase （ALT） in evaluating significant liver pathological injury in patients with chronic hepatitis B virus （HBV） infection， and to provide guidance for clinical diagnosis and treatment. MethodsThis study was conducted among 733 patients with chronic HBV infection who were hospitalized in Ningbo No. 2 Hospital from January 2015 to December 2023 and underwent liver biopsy and histopathological examination， and all patients had a persistent ALT level of ≤40 U/L and positive HBV DNA （>30 IU/mL）. According to the treatment threshold or ULN of ALT， the patients were divided into group 1 with 575 patients （≤35 U/L for male patients， ≤25 U/L for female patients）， group 2 with 430 patients （≤30 U/L for male patients， ≤19 U/L for female patients）， group 3 with 443 patients （≤27 U/L for male patients， ≤24 U/L for female patients）， group 4 with 446 patients （≤25 U/L）， group 5 with 158 patients （>35 U/L for male patients， >25 U/L for female patients）， and group 6 with 145 patients （>30 — ≤35 U/L for male patients， >19 — ≤25 U/L for female patients）. Groups 2， 5， and 6 were compared to analyze the severity of liver pathological injury in patients with different ALT levels and the constituent ratio of patients with significant liver pathological injury， and groups 1， 2， 3， and 4 were compared to investigate the value of different ULN or non-treatment thresholds of ALT in determining liver inflammation grade （G）， liver fibrosis stage （S）， and the treatment indication based on liver pathology. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test or the Tambane’s test was used for further comparison between two groups； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； a Ridit analysis was used for comparison of ranked data. A multivariate Logistic regression analysis （forward stepwise） was performed with whether liver pathology met the treatment indication （≥G2 and/or ≥S2） as the dependent variable and related factors with a significant impact on the dependent variable （P <0.05） as the independent variable. The receiver operating characteristic （ROC） curve was plotted， and the area under the ROC curve （AUC）， as well as sensitivity， specificity， positive predictive value， negative predictive value， positive likelihood ratio， and negative likelihood ratio， was used to assess the diagnostic value of different non-treatment thresholds of ALT. ResultsAmong the 733 patients， 259 （35.33%） had ≥G2 liver inflammation， 211 （28.79%） had ≥S2 liver fibrosis， and 306 （41.75%） had treatment indication （≥G2 and/or ≥S2）. There was a significant difference in liver inflammation grade （G0 — G4） between groups 2， 5， and 6 （χ²=22.869， P <0.001）， and there were also significant differences in the constituent ratios of patients with ≥G2 or ≥G3 liver inflammation between the three groups （χ²=21.742 and 14.921， P<0.001 and P=0.001）. There was a significant difference in liver fibrosis stage （S0 — S4） between groups 2， 5， and 6 （χ²=16.565， P<0.001）， and there were also significant differences in the constituent ratios of patients with ≥S2， ≥S3 or S4 liver fibrosis between the three groups （χ²=13.264， 13.050， and 6.260， P=0.001， 0.001， and 0.044）. There were significant differences between groups 2， 5， and 6 in the constituent ratios of patients with or without treatment indication based on liver pathology （χ²=20.728， P<0.001）. There were significant differences between groups 2， 5， and 6 in the constituent ratio of male patients （χ²=24.836， P<0.05）， age （F=5.710， P<0.05）， ALT （F=473.193， P<0.05）， aspartate aminotransferase （AST） （F=107.774， P<0.05）， ALT/AST ratio （F=40.167， P<0.05）， γ-glutamyl transpeptidase （GGT） （H=15.463， P<0.05）， aspartate aminotransferase-to-platelet ratio index （APRI） （H=63.024， P<0.05）， and LIF-5 （5 indicators for liver inflammation and fibrosis） （H=46.397， P<0.05）. In groups 1 — 4， compared with the patients without treatment indication， the patients with treatment indication had a significantly lower constituent ratio of patients with positive HBeAg， significantly lower levels of platelet count （PLT） and HBV DNA， and significantly higher age， ALT， AST， GGT， APRI， FIB-4， and LIF-5 （all P<0.05）. The Logistic regression analysis showed that age （odds ratio ［OR］=1.044， 95% confidence interval ［CI］： 1.025 — 1.063， P<0.001）， GGT （OR=1.022， 95%CI： 1.007 — 1.038， P=0.003）， and HBV DNA （OR=0.839， 95%CI： 0.765 — 0.919， P<0.001） were influencing factors for treatment indication based on liver pathology in group 1； HBeAg （OR=1.978， 95%CI： 1.269 — 3.082， P=0.003）， age （OR=1.048， 95%CI： 1.025 — 1.071， P<0.001）， GGT （OR=1.016， 95%CI： 1.001 — 1.031， P=0.041）， and PLT （OR=0.995， 95%CI： 0.991 — 1.000， P=0.049） were influencing factors in group 2； age （OR=1.040， 95%CI： 1.014 — 1.066， P=0.002）， ALT （OR=1.047， 95%CI： 1.005 — 1.092， P=0.029）， HBV DNA （OR=0.817， 95%CI： 0.736 — 0.907， P<0.001）， and LIF-5 （OR=7.382， 95%CI： 1.151 — 47.330， P=0.035） were influencing factors in group 3； age （OR=1.054， 95%CI： 1.031 — 1.077， P<0.001）， ALT （OR=1.061， 95%CI： 1.016 — 1.107， P=0.008）， and HBV DNA （OR=0.825， 95%CI： 0.743 — 0.917， P<0.001） were influencing factors in group 4. The diagnostic performance for identifying ≥G2 liver inflammation， ≥S2 liver fibrosis， and treatment indication in groups 1 — 4 had an AUC of >0.7； group 1 showed the lowest sensitivity （28.76%） and the highest specificity， positive predictive value， positive likelihood ratio， and negative likelihood ratio in judging treatment indication； group 2 had the highest sensitivity and negative predictive value and the lowest negative likelihood ratio； groups 3 and 4 had similar diagnostic indicators. ConclusionIn patients with chronic HBV infection and a persistently low ALT level， the severity of liver histopathological injury and the constituent ratio of significant liver histopathological injury decrease with the reduction in ALT level. A higher non-treatment threshold or ULN of ALT can help to identify the patients requiring treatment （with a higher specificity）， while a lower non-treatment threshold or ULN of ALT can help to identify the patients who do not require treatment （with a higher sensitivity）.

Objective To develop and validate a prediction model for risk of amputation in patients with diabetic foot ulcers(DFU)based on systematic review and meta-analysis.Methods The studies on the risk factors of amputation in DFU patients was retrieved by using subject words+free words.After screening,37 cohort studies were finally included,and the Newcastle-Ottawa scale(NOS)was used for quality evaluation.Meta-analysis was performed on the risk factors of amputation in DFU.Then a prediction model for DFU amputation risk were constructed based on the statistically significant risk factors in the meta-analysis.The corresponding β value was calculated based on the combined odds ratio(OR)value of each risk factor,and each risk factor was scored to establish a scoring system model.The clinical data of 453 DFU patients hospitalized in our department from 2021 to 2023 were collected as a validation cohort.Receiver operating characteristic(ROC)curve analysis was used to evaluate the model performance.The area under the curve(AUC)was calculated,and the optimal cutoff score was determined by calculation of the maximum Youden index through sensitivity and specificity.Results Our meta-analysis showed a cumulative amputation rate of approximately 34.65%in 11 779 DFU patients.The final risk prediction models include gangrene[OR=11.92(5.86～24.24)],ulcer depth[OR=4.93(2.52～9.64)],osteomyelitis[OR=3.19(2.36～4.29)],previous amputation history[OR=3.19(2.00～5.09)]and lower extremity arterial disease[OR=3.10(2.31～4.17)].According to the weights of each risk factor,the total score of the model is 76,and the optimal cut-off score is 36.5.The prediction model performed well,with an AUC value of 0.864(0.824,0.903),a sensitivity of 0.743,a specificity of 0.859,and an accuracy rate of 83.00%.Conclusion A prediction model for DFU amputation risk is developed based on risk factor scoring,and has good discrimination and calibration,providing effective scientific basis for clinical research and clinical decision-making related to DFU amputation.

Objective:To explore the relationship between the maternal dietary patterns during pregnancy and the early childhood BMI change trajectory.Methods:The subjects were 1 241 pairs of pregnant women and their children in Ma'anshan maternal and infant health cohort. The food frequency questionnaire was used to collect the maternal diet data during pregnancy. The cohort children were followed up at birth, month 3, 6, 12, 18 and 24, respectively. The body height and weight data of the cohort children were collected. The principal component analysis was used to determine the categories of maternal dietary patterns during pregnancy, group-based multi-trajectory modeling was used to fit the early childhood BMI change trajectory, and the multiple classification logistic regression model was used to evaluate the relationship between the maternal dietary patterns during pregnancy and the early childhood BMI change trajectory.Results:The maternal dietary patterns during pregnancy included protein type, healthy type, vegetarian type, processing type and beverage type, which could explain 50.04% of the total dietary variation. Among them, the protein type, main dietary pattern, could explain 21.34% of the total dietary variation. The early childhood BMI change trajectory was from thinnish stature to average stature, then to mild obesity, accounting for 42.9%, 45.6% and 11.5% respectively. After controlling the potential confounding factors, it was found that there was a statistical correlation between healthy type and beverage type of maternal dietary patterns during pregnancy and early childhood BMI change trajectory ( P<0.05). Comparison of change trajectories between thinnish type and average stature type, children in the low-level group of healthy diet pattern tended to have a thinnish type change trajectory in early life ( OR=1.286, 95% CI: 1.002-1.651). Comparison of change trajectories between mild obesity type and average stature type, children in the high-level group of beverage diet pattern tended to have a mild obesity type change trajectory in early life ( OR=0.565, 95% CI: 0.342-0.935). The other dietary patterns had no statistical correlation with the early childhood BMI change trajectory. Conclusions:Maternal dietary patterns during pregnancy can affect the early childhood BMI change trajectory, and the low-level healthy type diet is an independent risk factor for thinnish type change trajectory, and the high-level beverage type diet is an independent risk factor for the mild obesity type change trajectory.

Objective To explore the correlation between six characteristics of perioperative hypothermia and allogeneic red blood cell(RBC)transfusions in patients who underwent abdominal surgeries.Methods Patients who underwent abdominal surgeries at West China Hospital,Sichuan University between October 2019 and July 2021 were retrospectively enrolled.A wearable wireless temperature sensor was used to continuously monitor the core body temperature of patients throughout the perioperative period.The perioperative temperature nadir,maximum temperature loss,percentage of time with hypothermia,time-weigh ted average temperature,area under the curve(AUC)at 36 ℃,and AUC at 37 ℃ were calculated for the period from entering the operation room to 24 hours after the end of anesthesia.The restricted cubic spline(RCS)and multiple logistic regression models were used to explore the correlation between these temperature characteristics and perioperative allogeneic RBC transfusions.Results A total of 3119 patients were included in the study,with an allogeneic RBC transfusion rate of 2.8％.The RCS model showed that allogeneic RBC transfusion was associated with the perioperative temperature nadir(Poverall=0.048)and AUC at 36 ℃(Poverall=0.026)and no statistical significance was found in the nonlinear test.The association between allogeneic RBC transfusions and other temperature characteristics was not statistically significant.According to the RCS model results,cut-off points were taken to form groups based on the body temperature characteristics.Multivariate logistic regression showed that the perioperative temperature nadir＜35.5 ℃(odds ratio[OR]=2.47,95％confidence interval[CI]:1.21-5.03)and AUC at 36 ℃≥100 ℃·min(OR=2.24,95％CI:1.09-4.58)were associated with increased demand for allogeneic RBC transfusion.Conclusion Hypothermia is associated with an increased need for perioperative allogeneic RBC transfusions and has a cumulative effect over time.For patients at high risk of bleeding,attention should be paid to the prevention of perioperative hypothermia and reduction in the cumulative exposure to hypothermia,thereby reducing the need for blood transfusion.

Objective:To explore the application of flipped classroom combined with case workshop in general surgical practice teaching of undergraduate nursing students.Methods:The subjects of this study were nursing undergraduates practicing in general surgery department of a "three A" hospital. The experimental group included 44 interns from July 2019 to January 2020 who were taught by the flipped classroom combined with case workshop teaching mode. The control group included 45 interns from July 2018 to January 2019 who were given the traditional teaching mode. The two groups of students were evaluated for their clinical ability before and after the internship, and their out-department theoretical and operational performances were assessed and the survey of internship satisfaction was conducted. SPSS 19.0 was used for t test and chi-square test. Results:Before the internship, there was no statistical significance in the scores of clinical ability between the two groups ( P > 0.05). After the internship, the overall evaluation scores of clinical ability of the experimental group were (7.11±0.54) points, which were significantly higher than that of the control group (6.42±0.58) points ( t=-5.81, P < 0.001); the total satisfaction scores of the experimental group were (3.46±0.25) points, which were significantly higher than that of the control group (3.09±0.32) points ( t=-6.04, P < 0.001). The operation scores of the experimental group were (90.22±4.70) points, which were significantly higher than that of the control group (86.99±7.39) points ( t=-2.46, P=0.024). Conclusion:The teaching mode of flipped classroom combined with case workshop in nursing undergraduate general surgery practice can improve students' clinical ability and internship satisfaction, and improve the teaching effect of internship effectively.

Objective : To investigate the association between adiposity rebound and metabolic abnormalities in pre- schools． Methods : A prospective cohort study was designed on the basis of the Maanshan birth cohort． Venous blood samples were collected at 5 to 6 years of age to detect metabolic indicators．2022 children aged 0 to 6 years with ≥8 consecutive measurements were enrolled. χ2 test and Logistic regression model were used to analyze the data. Results : The detection rate of abnormal metabolism in preschool children was 16. 9% ，and the risk of meta- bolic abnormalities in preschool children with high BMI level at the AR time point and earlier AR time phase was 2. 59 and 1. 82 times that of the normal group respectively． Conclusion High AR level and earlier AR phase can increase the prevalence of metabolic abnormalities in preschool children.

Objective To explore the clinical effect of application of hospital information system in bedsore nursing process analysis.Methods To combine process management and continuous quality improvement organically,establish a complete set of the pressure ulcer management monitoring process,which was completed,networking,continuous for improvement and this process was used for the implementation of high-risk bedsore warning screening and bedsore informing,hospitalized patients with pressure ulcers online report system and level 3 monitoring system,bedsore nursing consultation system and pressure ulcer nursing intervention.Results The application of informatization in the pressure ulcer management process could effectively reduce the incidence of pressure ulcers,prompt bedsore nursing management level to be more standardized,scientific,and modernization.At the same time,it improved the patients' satisfaction degree with nursing work,meanwhile it let managers found that carrying out of pressure sores extended nursing service was imperative.Conclusions Application of hospital information system in bedsore nursing process analysis is satisfying,which is worthy of further development.

Objective To discuss the application effect of real time ratio of patients and nurses in nursing human resource dynamic management.Methods Our hospital made full use of the information platform,inquiring the real time ratio of patients and nurses,in combination with mobile nurse library,implement dynamic vertical management of nursing human resources on the level of the hospital-wide nursing management.The overall manpower cost remained the same through internal reasonable adjustment to achieve the best configuration of human resources and met the clinical needs effectively.Results The running effect was satisfactory from July 2012 till now.All the mobile nurses allocated were 71 person-times and the satisfaction degree of patients increased to 97.96％ in the first half of 2013.Conclusions Application of real time ratio of patients and nurses shows good effect,which is worthy of wide application.

Objective To explore a new method for one-stage repair of the intestinal leakage based on the principle of magnetic compression anastomosis. Methods Twenty-four dogs were randomly divided into experimental group (n = 12) and control group (n = 12) according to random number table. The model of upper and multiple intestinal leakages was established by making transverse incisions of 1 cm in length on the jejunum wall about 50 cm and 100 cm away from the Treitz ligament. Forty-eight hours later, two NdFeB magnetic rings with the magnetic flux of 2500 G were put into the intestine from the leak sites. The leak sites were pressed between the two rings. The ventages in the control group were sutured. The condition of the dogs was observed after the repair of the leakage. The excreting time was recorded, and the leakage pressures of the anastomotic stoma were detected.The positions of the magnetic rings in the experimental group were detected by X ray. Tissues of the anastomotic stoma were processed by hematoxylin eosin and Masson staining. All data were analyzed using the two-sample t test. Results Severe abdominal infection occurred 48 hours after the establishment of the model. All the intestinal leakages in the experimental group were successfully repaired and the dogs survived for a long time. The magnetic rings were excreted six or seven days after the repair. Eight dogs of the control group survived. The leakage pressure of the anastomotic stoma seven days after the repair was (134 ±23)mm Hg (1 mm Hg =0. 133 kPa) in the experimental group and (91 ± 18)mm Hg in the control group, respectively, with a significant difference between the two groups (t = 3.225, P ＜ 0.05). The leakage pressure of the anastomotic stoma 14 days after the repair was (281 ±7)mm Hg in the experimental group and (271 ±21) mm Hg in the control group, respectively, with no significant difference between the two groups (t =0. 988, P ＞ 0.05). Histological observation showed that after the magnetic compression anastomosis, the intestinal muscle and mucosa recovered well, inflammatory reaction was slight and less collagen fiber and scar was formed. Conclusions Application of magnetic ring with the magnetic flux of 2500 G in one-stage repair of the intestinal leakage in the state of severe abdominal infection is safe and reliable.

Objective To investigate and analyze the structure change of professional title and educa-tion background of nursing human resourse in Liaoning province in recent 3 years and raise up suggestions which suit for the structure and development of human resource of current nursing model. Methods Investi-gation scales for nursing human resource in Liaoning province were sent out to 85 hospitals in Liaoning province.SPSS 12.0 software was used to carry out statisdcal discription for these data. Results The main professional fide was primary. The main education background was junior college and technical secondary school in third-class hospitals and technical secondary school in second-class and first-class hospitals. Conclusions The professional title and education background of nursing human resourse in Liaoning province was not reasonable with imbalanced structure in various level of hespitals.The countermeasures included reform of nursing education, reasonable allocation and effective utilization of current nursing human resource and sys-tematization of continuing education.