Objective:To explore the risk factors of fungal infection in patients with upper urinary tract calculi after surgery and construct a risk prediction nomograph model.Methods:The clinical data of 2 329 patients who had undergone upper urinary calculus surgery in the Second Affiliated Hospital of Zhengzhou University from January 2019 to December 2023 were retrospectively analyzed. According to the presence or absence of fungal infection within 3 months after surgery, the patients were divided into fungal infection group (n=97) and non-fungal infection group (n=2 232). Univariate logistic regression analysis and LASSO regression were used to screen the potential influencing factors. The enrolled patients were randomly divided into a training set (n=1 630) and a validation set (n=699) at a ratio of 7∶3. Based on the training set, multivariate logistic stepwise regression was used to screen independent risk factors and to construct a nomogram. Based on the validation set, ROC curve, calibration curve and decision curve were drawn to evaluate the model's differentiation, accuracy and clinical applicability.Results:Univariate logistic regression analysis showed that female gender, age, diabetes mellitus, history of malignant tumor, long-term bedridden disease, long-term use of immunosuppressants, hemoglobin on admission, serum creatinine, uric acid, white blood cell count on admission, neutrophil count on admission, degree of hydronephrosis, preoperative indwelling ureteral stent, duration of surgery, postoperative fever within 48 hours, white blood cell count, neutrophil count, CRP, urinary catheter indwelling time, length of hospital stay, use of carbapenem antibiotics, the duration of antibiotic use and the duration of postoperative ureteral stent indwelling were related to fungal infection. screening after upper urinary calculi surgery ( P<0.05). Univariate logistic regression results were screened after LASSO regression. Multivariate logistic stepwise regression analysis for the training set showed that age ( OR=1.041, 95% CI 1.017-1.066, P=0.001), diabetes( OR=3.138, 95% CI 1.517-6.492, P=0.002), long-term bed-rest ( OR=10.627, 95% CI 3.671-30.767, P<0.001), history of malignant tumor( OR=11.934, 95% CI 5.473-26.022, P<0.001), white blood cell count on admission( OR=1.276, 95% CI 1.134-1.436, P<0.001), postoperative fever within 48 hours ( OR=3.940, 95% CI 1.956-7.937, P<0.001), use of carbapenem antibiotics( OR=5.826, 95% CI 2.783-12.196, P<0.001), length of hospital stay( OR=1.201, 95% CI 1.131-1.277, P<0.001), and postoperative retention time of ureteral stent( OR=1.205, 95% CI 1.104-1.315, P<0.001) were independent risk factors for fungal infection after upper urinary calculi surgery.The nomogram model was constructed based on independent risk factors. The results of ROC curve analysis showed that the AUC of the nomogram model in the prediction validation set was 0.955(95% CI 0.926-0.984). The calibration curve of the model was well fitted to the ideal curve. The results of decision curve analysis proved that the net benefit rate of the prediction model within the threshold range was higher than the two extreme lines when the threshold probability was <86%, indicating that the model was of good clinical applicability. Conclusions:Age, diabetes, history of malignant tumor, long-term bed-rest disease, white blood cell count on admission, postoperative fever within 48 hours, use of carbapenem antibiotics, length of hospital stay, and postoperative retention time of ureteral stent are independent risk factors for fungal infection in patients with upper urinary calculi after surgery. The model constructed in this study has good predictive ability and clinical applicability for the risk of fungal infection in patients with upper urinary calculi after surgery.

Objective To explore the clinical characteristics and risk factors of upper urinary tract stones complicated with non-alcoholic fatty liver disease(NAFLD),so as to provide reference for the prevention of this disease.Methods The clinical data of 158 NAFLD patients undergoing surgical treatment in our hospital during Jan.2022 and Jul.2023 were retrospectively analyzed.According to whether the patients were complicated with NAFLD,they were divided into the NAFLD group(n=56)and non-NAFLD group(n=102).The general data,laboratory indexes and 24-h urinary metabolic indexes were compared between the two groups,and the risk factors were analyzed with univariate and multivariate logistic regression analyses.Results Compared with the non NAFLD group,the NAFLD group had higher BMI[(28.17±4.17)vs.(24.11±3.72),P＜0.001],blood uric acid[(354.13±111.01)μmol/L vs.(294.41±93.72)μmol/L,P＜0.001],and 24-h urinary oxalate level[(37.74±15.00)mmol vs.(27.73±15.27)mmol,P＜0.001].Multivariate logistic analysis showed that BMI(OR=1.311,P＜0.001),24-h urinary oxalate(OR=1.046,P=0.004),and 24-h urinary magnesium(OR=0.599,P=0.002)were the independent factors for NAFLD with upper urinary tract stones.Conclusion NAFLD complicated with upper urinary tract stones is significantly associated with high BMI,high 24-h urinary oxalate,and low 24-h urinary magnesium.

Objective:To investigate the reliability and validity of the China Nanjing consciousness recovery scale(CNCRS)in assessing patients with acute disorder of consciousness(DOC).Method:A total of 306 patients with acute DOC admitted to Nanjing Zijin Hospital between August 2023 and August 2024 were enrolled.Each patient was assessed using both the Glasgow Coma Scale(GCS)and CNCRS.The correlation between GCS and CNCRS scores were analyzed,and the reliability and validity of these two scales were compared.Result:The DOC degree of enrolled patients was severe,with a tracheotomy rate of 61.8%.The median GCS score was 7(5,10)for males and 6(5,9)for females,while the median CNCRS score was 3(1,8)for males and 3(1,7)for females.Scores from both scales were statistically significant correlated across gender groups(P<0.001).The Cron-bach's α coefficient of CNCRS(male 0.918,female 0.889)was higher than that of GCS(male 0.687,female 0.658),indicating superior internal consistency.The validity index Kaiser-Meyer-Olkin(KMO)value(male 0.891,female 0.857)was also higher than the GCS scale(male 0.600,female 0.602),demonstrating better construct validity.Conclusion:The CNCRS demonstrates good reliability and validity and can be effectively applied for the evalu-ation of patients with acute disturbance of consciousness.

Objective To explore the clinical characteristics and risk factors of upper urinary tract stones complicated with non-alcoholic fatty liver disease(NAFLD),so as to provide reference for the prevention of this disease.Methods The clinical data of 158 NAFLD patients undergoing surgical treatment in our hospital during Jan.2022 and Jul.2023 were retrospectively analyzed.According to whether the patients were complicated with NAFLD,they were divided into the NAFLD group(n=56)and non-NAFLD group(n=102).The general data,laboratory indexes and 24-h urinary metabolic indexes were compared between the two groups,and the risk factors were analyzed with univariate and multivariate logistic regression analyses.Results Compared with the non NAFLD group,the NAFLD group had higher BMI[(28.17±4.17)vs.(24.11±3.72),P＜0.001],blood uric acid[(354.13±111.01)μmol/L vs.(294.41±93.72)μmol/L,P＜0.001],and 24-h urinary oxalate level[(37.74±15.00)mmol vs.(27.73±15.27)mmol,P＜0.001].Multivariate logistic analysis showed that BMI(OR=1.311,P＜0.001),24-h urinary oxalate(OR=1.046,P=0.004),and 24-h urinary magnesium(OR=0.599,P=0.002)were the independent factors for NAFLD with upper urinary tract stones.Conclusion NAFLD complicated with upper urinary tract stones is significantly associated with high BMI,high 24-h urinary oxalate,and low 24-h urinary magnesium.

Objective:To investigate the reliability and validity of the China Nanjing consciousness recovery scale(CNCRS)in assessing patients with acute disorder of consciousness(DOC).Method:A total of 306 patients with acute DOC admitted to Nanjing Zijin Hospital between August 2023 and August 2024 were enrolled.Each patient was assessed using both the Glasgow Coma Scale(GCS)and CNCRS.The correlation between GCS and CNCRS scores were analyzed,and the reliability and validity of these two scales were compared.Result:The DOC degree of enrolled patients was severe,with a tracheotomy rate of 61.8%.The median GCS score was 7(5,10)for males and 6(5,9)for females,while the median CNCRS score was 3(1,8)for males and 3(1,7)for females.Scores from both scales were statistically significant correlated across gender groups(P<0.001).The Cron-bach's α coefficient of CNCRS(male 0.918,female 0.889)was higher than that of GCS(male 0.687,female 0.658),indicating superior internal consistency.The validity index Kaiser-Meyer-Olkin(KMO)value(male 0.891,female 0.857)was also higher than the GCS scale(male 0.600,female 0.602),demonstrating better construct validity.Conclusion:The CNCRS demonstrates good reliability and validity and can be effectively applied for the evalu-ation of patients with acute disturbance of consciousness.

Objective:To explore the risk factors of fungal infection in patients with upper urinary tract calculi after surgery and construct a risk prediction nomograph model.Methods:The clinical data of 2 329 patients who had undergone upper urinary calculus surgery in the Second Affiliated Hospital of Zhengzhou University from January 2019 to December 2023 were retrospectively analyzed. According to the presence or absence of fungal infection within 3 months after surgery, the patients were divided into fungal infection group (n=97) and non-fungal infection group (n=2 232). Univariate logistic regression analysis and LASSO regression were used to screen the potential influencing factors. The enrolled patients were randomly divided into a training set (n=1 630) and a validation set (n=699) at a ratio of 7∶3. Based on the training set, multivariate logistic stepwise regression was used to screen independent risk factors and to construct a nomogram. Based on the validation set, ROC curve, calibration curve and decision curve were drawn to evaluate the model's differentiation, accuracy and clinical applicability.Results:Univariate logistic regression analysis showed that female gender, age, diabetes mellitus, history of malignant tumor, long-term bedridden disease, long-term use of immunosuppressants, hemoglobin on admission, serum creatinine, uric acid, white blood cell count on admission, neutrophil count on admission, degree of hydronephrosis, preoperative indwelling ureteral stent, duration of surgery, postoperative fever within 48 hours, white blood cell count, neutrophil count, CRP, urinary catheter indwelling time, length of hospital stay, use of carbapenem antibiotics, the duration of antibiotic use and the duration of postoperative ureteral stent indwelling were related to fungal infection. screening after upper urinary calculi surgery ( P<0.05). Univariate logistic regression results were screened after LASSO regression. Multivariate logistic stepwise regression analysis for the training set showed that age ( OR=1.041, 95% CI 1.017-1.066, P=0.001), diabetes( OR=3.138, 95% CI 1.517-6.492, P=0.002), long-term bed-rest ( OR=10.627, 95% CI 3.671-30.767, P<0.001), history of malignant tumor( OR=11.934, 95% CI 5.473-26.022, P<0.001), white blood cell count on admission( OR=1.276, 95% CI 1.134-1.436, P<0.001), postoperative fever within 48 hours ( OR=3.940, 95% CI 1.956-7.937, P<0.001), use of carbapenem antibiotics( OR=5.826, 95% CI 2.783-12.196, P<0.001), length of hospital stay( OR=1.201, 95% CI 1.131-1.277, P<0.001), and postoperative retention time of ureteral stent( OR=1.205, 95% CI 1.104-1.315, P<0.001) were independent risk factors for fungal infection after upper urinary calculi surgery.The nomogram model was constructed based on independent risk factors. The results of ROC curve analysis showed that the AUC of the nomogram model in the prediction validation set was 0.955(95% CI 0.926-0.984). The calibration curve of the model was well fitted to the ideal curve. The results of decision curve analysis proved that the net benefit rate of the prediction model within the threshold range was higher than the two extreme lines when the threshold probability was <86%, indicating that the model was of good clinical applicability. Conclusions:Age, diabetes, history of malignant tumor, long-term bed-rest disease, white blood cell count on admission, postoperative fever within 48 hours, use of carbapenem antibiotics, length of hospital stay, and postoperative retention time of ureteral stent are independent risk factors for fungal infection in patients with upper urinary calculi after surgery. The model constructed in this study has good predictive ability and clinical applicability for the risk of fungal infection in patients with upper urinary calculi after surgery.

Objective:To evaluate the clinical efficacy of Guizhi Mahuang Geban Decoction combined with conventional western medicine in the treatment of post infections cough (PIC), and to explore the mechanism.Methods:A total of 100 PIC patients in our hospital from January 2020 to July 2021 who met the inclusion criteria were divided into 2 groups according to the random number table method, with 50 in each group. The control group was treated with conventional western medicine, and the study group was treated with Guizhi Mahuang Geban Decoction and the treatment of the control group. Both groups were treated for 10 days. TCM symptom scores were performed before and after treatment. The levels of neurokinin A (NKA), substance P (SP), neurokinin B (NKB) and calcitonin gene related peptide (CGRP) were detected by ELISA. Adverse events were recorded and clinical effects were evaluated.Results:The total clinical effective rate was 90.0% (45/50) in the study group and 68.0% (34/50) in the control group, and there was significant difference between the two groups ( χ2=7.29, P=0.007). The scores of cough, expectoration, pharyngeal itch and total score in the study group were significantly lower than those in the control group ( t values were 8.04, 6.30, 9.03, 9.71, all Ps<0.01). After treatment, NKA [(86.08±18.21) ng/L vs. (137.68±28.29) ng/L, t=10.85], SP [(54.23±11.28) ng/L vs. (71.75±15.34) ng/L, t=6.51], NKB [(96.15±20.19) ng/L vs. (149.84±30.22) ng/L, t=10.45], CGRP [(62.93±18.35) ng/L vs. (89.59±23.25) ng/L, t=6.37] levels in the study group were significantly lower than those in the control group ( P<0.01). The incidence of adverse events was 8.0% (4/50) in the control group and 10.0% (5/50) in the study group, and there was no significant difference between the two groups ( χ2=0.13, P=0.727). Conclusions:Compared with western medicine alone, Guizhi Mahuang Geban Decoction combined with western medicine can rapidly improve patients' symptoms, improve curative effect and have better safety for PIC. Its mechanism may be related to the regulation of NKA, SP, NKB and CGRP levels.

Objective To carry out innovative practice as well as questionnaire survey and conduct promotion analysis of clinical molecular biology testing based on problem-based learning (PBL). Methods 137 Students of medical laboratory technology discipline were chosen as subjects to conduct the innovative practice of PBL method. The teaching results were shared and promoted by video online through WeChat. Micro-questionnaire was conducted in 335 students, and the results of the survey were statistically analyzed. Result The improved PBL teaching based on speech contest can boost students to integrate into classroom teaching actively in which they had a better understanding of the knowledge so that the expected teaching quality of clinical molecular biology testing was achieved effectively. Questionnaire showed that the impact of PBL teaching method on students was not extensive currently, indicating that there was still more space to promoting such teaching methods. Although traditional teaching methods still held a place in students' minds (43.9%, 147 cases), the innovative teaching of PBL, which is novel, interesting and colorful, is more in line with the expectations of medical laboratory students in the new era and has the highest acceptance (49.6%, 166 cases). Conclusion The innovative practice of PBL teaching based on speech contest can achieve the purpose of strengthening students' knowledge acquisition and flexibility in the practical use of knowledge, which is worthy of promoting. Teachers could gradually integrate the new PBL teaching model into the tradi-tional teaching methods in the future, making students study efficiently in a relaxed and active atmosphere

Objective After acute craniocerebral trauma , to a certain extent , arterial blood lactate and lactate clearance rate reflect the illness severity .We aimed to investigate the prognosis value of arterial blood lactate and lactate clearance rate in patients with craniocerebral trauma . Methods 94 cases with craniocerebral trauma treated in the Department of Emergency of Nanjing General Hospital of Nanjing Military Regionfrom February 2015 to November 2015 were retrospecively analysed .GCS ( Glasgow Coma Scale ) score, arterial blood lactate , blood pressureand heart rate were measured once patients admitted to hospital and 6 hours later ,arterial blood lactate was measured again to calculated the arterial blood lac-tate clearance rate .Based on the GCS score , we divided the patients into mild group (13-15), medium group (9-12) and severe group (3-8).We also divided the patients into death group and survival group according toprognosis .We compared arterial blood lactate and lactate clearance rate betweeeneach group respectively . Results There were significant differences in arterial blood lactate (F=19.99,P<0.01) and 6h lactate clearance rate(F=6.21,P<0.01)be-tween lighter group , medium group and severe group .The initial arterial blood lactate of death group was significantly higher than sur-vival group[(4.20 ±1.36)mmol/L vs (1.58 ±0.93)mmol/L], the difference was statistically significant (t=-9.78,P<0.01). The 6 h lactate clearance rate of death group was significantly lower than survival group [(31.73 ±12.84)%vs (46.25 ±12.01)%], the difference was statistically significant (t=4.55,P<0.01). Conclusion Arterial blood lactate and 6 h lactate clearance rate can evaluate the severity and prognosisof illnessin patients with craniocerebral traumaand have important application value in clinical work .