Objective To predict whether antiviral therapy is required in patients with chronic hepatitis B virus(HBV)infection and an age of≤30 years by establishing a noninvasive model,and to investigate the diagnostic value of this model.Methods A retrospective analysis was performed for the clinical data of 175 patients with chronic HBV infection who were admitted to Shenzhen Third People's Hospital from January 2017 to January 2023 and met the inclusion criteria,and according to the results of liver biopsy,they were divided into treatment group with 41 patients(with indications for antiviral therapy)and observation group with 134 patients(without indications for antiviral therapy).The two groups were analyzed in terms of the indicators including clinical data,imaging examinations,and serum biochemical parameters.The univariate and multivariate Logistic regression analyses were used to investigate the parameters affecting the indication for antiviral therapy,and different models for predicting the need for antiviral therapy were constructed based on related parameters.The receiver operating characteristic(ROC)curve was used to compare the diagnostic value of different models.The independent-samples t test was used for comparison of normally distributed continuous variables between groups,and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous variables between groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.Results There were significant differences between the treatment group and the observation group in alanine aminotransferase,ferritin,total cholesterol(CHOL),triglyceride,platelet count,liver stiffness measured by sound touch elastography(STE),and procollagen Ⅲ N-terminal propeptide(PIIIP)(all P<0.05).The multivariate Logistic regression analysis showed that CHOL(odds ratio[OR]=0.4,95％confidence interval[CI]:0.2—1.0),STE(OR=1.5,95％CI:1.0—2.1),and PIIIP(OR=1.1,95％CI:1.0—1.1)were independent predictive factors for the indications for antiviral therapy.Model 1(STE+PIIIP+CHOL),model 2(STE+PIIIP),model 3(STE+CHOL),model 4(PIIIP+CHOL)had an area under the ROC curve of 0.908,0.848,0.725,and 0.725,respectively,while STE,PIIIP,and CHOL used alone had an AUC of 0.836,0.725,and 0.634,respectively,suggesting that model 1 had the largest AUC,with a specificity of 77.34％and a sensitivity of 96.36％,and had a significant difference compared with STE,PIIIP,CHOL,and the models 2,3,and 4(Z=0.21,3.08,3.06,3.23,0.89,and 0.88,all P<0.05).Conclusion The noninvasive model established based on CHOL,STE,and PIIIP has a good value in predicting the need for antiviral therapy in patients with chronic HBV infection and an age of≤30 years.

Objective:To evaluate the arousal effect of plantar reflex area and acupoint massage combined with music therapy in patients with brain trauma and coma.Methods:From March 2022 to March 2023, 90 patients with brain trauma and coma who were treated in the Neurosurgery Intensive Care Unit of Tangshan Gongren Hospital in Hebei Province were selected as the research subject. According to the random number table method, patients were divided into a control group, experimental group 1, and experimental group 2, with 30 cases in each group. The control group received routine nursing for brain trauma, while the experimental group 1 received music therapy with the natural voice on the basis of the control group. The experimental group 2 was treated with plantar reflex area and acupoint massage treatment on the basis of the experimental group 1. This study compared the Glasgow Coma Scale (GCS) scores and Coma Recovery Scale-Revised (CRS-R) scores of three groups of patients before and after intervention.Results:After 2, 4, and 6 weeks of intervention, the GCS scores and CRS-R scores of patients in experimental group 2 were higher than those in the control group and experimental group 1, with statistically significant differences ( P<0.05) . Conclusions:The combination of plantar reflex area and acupoint massage with music therapy has a certain arousal effect on patients with brain trauma and coma, and can be promoted and applied in clinical practice.

Objective To investigate the predictive value of Glasgow coma scale(GCS)-Full Out-line of UnResponsiveness(FOUR)scale(GCS-F)score and arterial lactate level for prognosis of intracerebral hemorrhage(ICH)in elderly patients.Methods A total of 278 elderly ICH patients admitted to Neurosurgical Intensive Care Unit of the Affiliated Hospital of North China Universi-ty of Science and Technology from January 2022 to January 2024 were retrospectively recruited.According score at 90 d after onset,95 of them were assigned into good prognosis group and 183 into poor prognosis group.Basic information,vital signs at admission,pupils,laboratory indica-tors,GCS score and other clinical data were compared between the two groups.Binary logistic re-gression analysis was used to analyze the risk factors of poor prognosis in elderly ICH patients.ROC curve was drawn to analyze the prognostic value of GCS-F score(including eye opening re-sponse and limb movement in GCS,and brainstem response in FOUR scale)combined with lac-tate level in elderly ICH patients.Results Significantly higher blood pressure,elevated levels of blood glucose,creatinine and arterial lactic acid,increased percentages of supratentorial and sub-tentorial bleeding,and larger blood loss,while obviously lower GCS score and GCS-F score were observed in the poor prognosis group than the good prognosis group(P＜0.05,P＜0.01).In the analyses for poor prognosis rate of ICH patients at different levels,the poor prognosis rate of se-vere GCS-F patients was significantly higher than that of patients with same level of GCS score(P＜0.05).Binary logistic regression analysis showed that GPS-F score(OR=1.762,95％CI:1.507-2.061,P=0.000)and arterial lactate level(OR=0.536,95％CI:0.385-0.746,P=0.000)were risk factors for 90-day poor prognosis in elderly ICH patients.ROC curve analysis indicated that the AUC value of arterial lactate,GCS score and GCS-F score in predicting 90-day poor prog-nosis in elderly ICH patients was 0.713(95％CI:0.650-0.775),0.827(95％CI:0.774-0.880)and 0.876(95％CI:0.828-0.925),respectively,and the AUC value of GCS-F score combined with arterial lactic acid was 0.919(95％CI:0.886-0.953),which was significantly higher than that of GCS score,GCS-F score and arterial lactic acid alone(P＜0.01).Conclusion GCS-F score has better performance than GCS score in predicting 90-day poor prognosis in elderly ICH pa-tients,especially for severe patients.The GPS-F score combined with arterial lactate level shows the best predictive effectiveness for elderly ICH patients.

Objective:To explore any effect of standing balance dynamic lifting training on balance, motor functioning and the life quality of hemiplegic stroke survivors.Methods:Eighty stroke survivors were randomly divided into a control group and an experimental group, each of 40. Both groups received routine rehabilitation training, while the experimental group additionally underwent standing balance dynamic lifting training. Before the intervention, and 2 and 4 weeks later, everyone′s balance and motor functioning were evaluated using the Brunel balance assessment (BBA) and the timed " up and go" test (TUGT). Life quality was quantified using the stroke special quality of life scale (SS-QOL).Results:Significant improvement in the average walking function score, BBA total score and TUGT time was observed in both groups, with significantly greater improvement after 4 weeks than after two. The improvements in the experimental group were significantly greater than in the control group. After 4 weeks the average total SS-QOL score and the scores on all of its dimensions had increased significantly in the experimental group. The scores for energy, language, motor function, emotions, self-care ability, upper limb function and the average SS-QOL total score were all then significantly better in the experimental group.Conclusions:Standing balance dynamic lifting training can effectively improve the balance, motor function and life quality of stroke survivors with hemiplegia.

With the comprehensive quality of nursing undergraduates cultivation as the core, the construction of "Curriculum Ideological and Political System" follows the law of ideological work, the rules of teaching and the rules of student growth, to change according to the events, to progress according to the period, and to update according to the situation. This paper attempts to instruct the ways of building the first class with multiple ways, building the second-class education by three platform and three integrations, and establishing a multi-time, multi-dimensional and multi-way evaluation system for the educational effect, so as to promote the quality of nursing professionals to higher level.

Objective:To analyze the independent risk factors for the occurrence of post-traumatic cognitive dysfunction, construct a prediction model for the risk factors of post-traumatic cognitive dysfunction, and verify the effectiveness of the risk prediction model, so as to provide a clinical tool for early prediction of the risk of post-traumatic cognitive impairment.Methods:Part I: patients with brain trauma (training set with 556 subjects) who were hospitalized in 21 tertiary and secondary hospitals from Tangshan, Cangzhou and Chengde cities of Hebei province were retrospectively collected from February to May 2021 for Montreal cognitive assessment, and 33 influencing factors (general data, symptoms and signs, laboratory and imaging parameters) were obtained obtained through literature research.The patients were divided into case group and control group according to whether they had cognitive impairment or not, and univariate and multivariate analysis were used to screen independent risk factors.Part Ⅱ: a binary Logistic regression equation was used to construct a cognitive impairment prediction model, the visualization model of line graph is presented.Part Ⅲ: brain trauma patients (260 subjects of the validation set) hospitalized in the aforementioned 21 hospitals from August to October 2021 were collected as a prospective validation population for the prediction model of cognitive impairment, and the grouping basis of case group and control group was the same as before.And the risk factors between the two groups were compared.The receiver operating characteristic curve(ROC), calibration curve and clinical applicability of the model were drawn to evaluate the effectiveness of the model for internal and external verification of the model.Results:Binary Logistic regression analysis showed that the risk factors for post-traumatic cognitive dysfunction were basal ganglia injury, severe injury, amnesia experience after injury, frequent headache after injury, upper limb dysfunction after injury, age ≥ 60 years, and education level of elementary school or below.Visual nomograms showed that the experience of amnesia after injury, frequent headache after injury, upper limb dysfunction, and degree of injury among the symptom factors were the factors that contributed greatly to the risk of traumatic brain injury cognitive impairment in this model.Predictive model discrimination using area under curve(AUC) values of the area under the ROC curve showed that internal validation and external validation were 0.868 and 0.885 for R language analysis and 0.868 and 0.901 for SPSS analysis, respectively.The curve after model calibration almost coincided with the reference line, Hosmer-Lemeshow test P>0.05.The two decision curve analysis (DCA) curves drawn by the clinical applicability of the model were higher than the two extreme curves, predicting that traumatic brain injury patients with cognitive impairment could benefit from the predictive model, and there was a net benefit rate in the range of Pt about 0.1-0.8, when Pt reached about 0.1 until the approximate 1.0 composite evaluation model. Conclusion:Risk factors such as experience of amnesia after injury, frequent headache after injury, upper limb dysfunction, and degree of injury are predicting factors contributed to the risk of cognitive impairment in traumatic brain injury, and their prediction models have good predictive effect, high predictive accuracy and good clinical applicability, which can be applied in clinical diagnosis.

Objective To investigate the risk factors of cognitive dysfunction in patients with traumatic brain injury. Methods From March to September, 2021, 556 hospitalized patients with traumatic brain injury were selected from a multicenter study. A 1∶1 sex-matched case-control study design was used. After assessment by Montreal Cognitive Assessment (MoCA), those with cognitive impairment were as case group and those without cognitive impairment were as control group. They were collected general data and assessed with Social Support Rating Scale (SSRS) and Hospital Anxiety and Depression Scale (HADS). Results Logistic regression analysis showed that college education or above (OR = 0.040) and high level of social support (OR = 0.118) were protective factors for cognitive impairment (P < 0.05). Aged 60 to 88 years (OR = 9.996), severe brain injury (OR = 7.345), headache after injury (OR = 2.159), frequent waking at night or multiple dreams ≥ three times per week (OR = 3.705), severe upper limb dysfunction caused by brain injury (OR = 6.072), depression (OR = 5.202) were risk factors for cognitive impairment (P < 0.05). Conclusion The related factors for cognitive impairment in patients with traumatic brain injury include general factors, disease factors, sleep, psychological and social support and other factors. It is suggested that in addition to the treatment of disease, it is necessary to improve sleep, psychology and social support, to reduce the incidence of cognitive impairment and promote the recovery of disease.

Objective:To investigate the expression and prognostic value of glycolytic metabolism related methyltransferase-like 3 (METTL3) in resectable primary liver cancer.Methods:The METTL3 mRNA expression data, clinicopathological data and prognostic information of 364 patients with primary liver cancer and 50 healthy normal liver tissues were downloaded from the Cancer Genome Atlas (TCGA) database, and gene set enrichment analysis was performed. Then the tissue samples of 239 patients with primary liver cancer who underwent radical hepatectomy in Chongqing Armed Police Corps Hospital from January 2016 to may 2019 were selected. Among them, 110 cases contained matched normal liver tissue adjacent to the cancer. The expression of METTL3 protein was detected by immunohistochemical staining. Kaplan-Meier survival curve was drawn, and log-rank test was used for comparison; Cox proportional hazard model was used to evaluate the risk factors affecting the prognosis in patients with primary liver cancer.Results:TCGA database analysis result showed that the expression level of METTL3 mRNA in liver cancer tissue was significantly higher than that in normal liver tissue: 3.72 (3.19, 4.03) vs. 2.45 (2.11, 2.68), and there was statistical difference ( P = 0.007); Kaplan-Meier survival curve analysis result showed that the median overall survival time and disease-free survival time in patients with high expression of METTL3 mRNA were significantly shorter than those in patients with low expression of METTL3 mRNA (43.0 months vs. 72.0 months and 22.0 months vs. 38.0 months, HR = 1.7 and 1.4, P = 0.002 and 0.024). Gene set enrichment analysis result showed that METTL3 mRNA was related to impaired glucose metabolism. In the clinical sample study, the positive expression rate of METTL3 protein in liver cancer tissue was significantly higher than that in normal liver tissue adjacent to cancer: 54.55% (60/110) vs. 14.55% (16/110), and there was statistical difference ( χ2 = 38.92, P<0.01). Among 239 patients with primary liver cancer, 132 cases (55.23%) had positive expression of METTL3 protein in liver cancer tissue, and 107 cases had negative expression. Compared with METTL3 protein negative patients, METTL3 protein positive patients had higher body mass index; higher TNM stage, BCLC stage and tissue grade; more lesions; larger tumor sizes; more common satellite nodules; higher leukocyte count, platelet count and neutrophil count, and there were statistical differences ( P<0.05 or <0.01). Kaplan-Meier survival curve analysis result showed that the median overall survival time and disease-free survival time in patients with METTL3 protein positive were significantly shorter than those in patients with METTL3 negative (18.0 months vs. 38.0 months and 13.0 months vs. 27.0 months, P<0.01). Univariate and multivariate Cox analysis result showed that METTL3 protein positive in liver cancer tissue was an independent risk factor affecting overall survival time and disease-free survival time ( HR = 1.840 and 2.096, 95% CI 1.298 to 2.608 and 1.469 to 2.991, P<0.01). Conclusions:METTL3 is involved in glycolytic metabolism of primary liver cancer, and can be used as a promising biomarker to evaluate the prognosis of patients with primary liver cancer.

Objective:To explore the relationship between cardiac discomfort symptoms, fear of disease progress and post-traumatic stress disorder (PTSD) in patients with acute myocardial infarction(AMI) after discharge, and to clarify main intervention direction of PTSD in patients with AMI.Methods:Patients with AMI who were discharged from Tangshan Gongren Hospital between 1 month and 1 year were selected from November 2019 to November 2020.The cardiac discomfort symptoms scale, fear of progress questionnaire(FoP-Q-SF) and post-traumatic stress disorder self-rating scale(PTSD-SS) were used to investigate cardiac discomfort symptoms, fear of disease progress level and post-traumatic stress disorder status.Spearman rank correlation analysis was used to analyze the relationship between cardiac discomfort symptoms, fear of disease progress and post-traumatic stress disorder by SPSS 24.0 software. The mediating effect of fear of disease progress was analyzed by AMOS 24.0 software.Results:The PTSD score was (32.78±12.38) of patients with AMI discharged from hospital for 1 month to 1 year and the incidence of PTSD was 12.3%.Spearman correlation test showed cardiac discomfort symptoms and fear of disease progress were positively correlated with PTSD( r=0.530, 0.723, both P<0.01) and cardiac discomfort symptoms was positively correlated with fear of disease progress( r=0.518, P<0.01). Mediating effect test showed that fear of disease progress was a complete mediator between cardiac discomfort symptoms and PTSD. Conclusion:Cardiac discomfort symptoms can affect PTSD through a complete mediator of fear of disease progress.

Objective:To explore the intervention effects of high and low audio-motor stimulation mode on attention and memory of elderly with mild cognitive impairment in rural areas.Methods:From September 2019 to May 2020, 80 subjects with mild cognitive impairment meeting the inclusion and exclusion criteria were selected and randomly divided into experimental group and control group according to the drawing lots, with 40 participants in each group.The experimental group was given high and low audio-motor stimulation mode training, and the control group was given finger exercises training.Before and after the intervention, sustained and selective attention were assessed using number cancellation test(NCT), E-Prime paradigm based on Stroop effect design, and memory was assessed using the Rivermead behavioral memory test, version 2 (RBMT-Ⅱ). SPSS 17.0 software was used to perform data statistics. The independent sample t test, paired sample t test and Mann Whitney U test were used for statistical analysis. Results:After intervention, the sustained attention index of the experimental group (0.86±0.48) was significantly higher than that of the control group (0.63±0.47, t=4.336, P<0.05). After intervention, the unanimous response time of the experimental group ((2 263.38±437.87) ms) and the reverse reaction time ((2 335.75±599.86) ms) were significantly lower than those of the control group ((2 703.95±506.34) ms, (2 667.43±585.38) ms) ( t=-4.068, -2.447, P<0.05). The consistent correct rate ((0.84±0.14)) and the reverse correct rate ((0.87±0.10))were significantly higher than those of the control group ((0.71±0.19), (0.73±0.15)) ( t= 3.571, 4.931, both P<0.05). RBMT-Ⅱ dimensions and total standard scores of the experimental group (19.00 (18.00, 20.00)) were higher than those of the control group (11.00 (10.00, 12.00))( Z=7.299, P<0.05). Conclusion:High and low audio-motor stimulation improves attention and memory in rural elderly with mild cognitive impairment.