Objective To investigate the application value of tenofovir alafenamide fumarate (TAF) in elderly patients with chronic hepatitis B (CHB) and its influence on bones and kidneys. Methods A total of 36 CHB patients, aged ≥60 years, who received TAF antiviral therapy in Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qingdao Sixth People's Hospital, Chengyang People's Hospital, and Jimo People's Hospital from June 2021 to October 2022 were enrolled in this study, and all patients received TAF (25 mg/d) antiviral therapy. Related data were collected at baseline and weeks 24 and 48 of treatment, including virological indicators, biochemical parameters, urinary protein electrophoresis indices, transient elastography (FibroScan), and bone mineral density. Virological indicators included high-sensitivity HBV DNA quantification; biochemical parameters included total bilirubin, direct bilirubin (DBil), indirect bilirubin (IBil), alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bile acid (TBA), glucose, blood urea nitrogen, creatinine, estimated glomerular filtration rate, and cystatin C (Cys C); urinary protein electrophoresis indices included urinary β2 microglobulin (β2-MG), urinary retinol (URBP), and urinary α1 microspherin (α1-MG). The paired t -test was used for comparison of normally distributed continuous data before and after treatment, and the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment; the chi-square test or the Fisher's exact test was used for comparison of categorical data. Results A total of 36 CHB patients completed 24 weeks of follow-up. The complete virological response rate after 24 weeks of treatment was higher than that at baseline [83.3% (30/36) vs 77.8% (28/36), χ 2 =0.36, P =0.55], and there were significant reductions in DBil ( t =-2.42, P =0.02) and Cys C ( t =-4.34, P < 0.001) from baseline to week 24. A total of 18 CHB patients completed 48 weeks of follow-up. The complete virological response rate after 48 weeks of treatment was higher than that at baseline (94.4% vs 77.8%, χ 2 =2.22, P =0.34), and there were significant increases in IBil ( t =2.43, P =0.03), TBA ( Z =-2.24, P =0.03), and bone mineral density T score of lumbar vertebra ( t =2.92, P = 0.01) and femoral neck ( t =2.42, P =0.03) and a significant reduction in liver stiffness measurement ( t =-2.31, P =0.03). There were no significant changes in β2-MG, URBP, and α1-MG after treatment (all P > 0.05). Conclusion TAF has a good antiviral effect in CHB patients aged ≥60 years and can help more CHB patients achieve complete virological response, without causing damage to the kidney, and it can also improve bone mineral density and liver fibrosis degree.

Objective:To investigate the risk factors for cerebral injury in survivors of twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser occlusion of chorioangiopagous vessels(FLOC) and to analyze the neurodevelopmental outcomes at 12 months of corrected age.Methods:A total of 136 cases of TTTS receiving FLOC in the Third Affiliated Hospital of Zhengzhou University from May 2018 to August 2021 were retrospectively selected as the FLOC group, and the survivors were followed up. Neurological development at 12 months of corrected age was assessed using the Griffiths mental development scales-Chinese (GDS-C) from five dimensions with locomotor, personal-social, hearing and language, hand-eye coordination and performance subscales. Eighty-eight fetuses of TTTS pregnancies receiving expectant treatment or amniotic fluid reduction were selected as the non-FLOC group. The perinatal mortality and the incidence of cerebral injury in the two groups were compared, as well as the incidence of cerebral injury between patients undergoing Solomon surgery and selective laser surgery in the FLOC group. Generalized estimating equations were used to analyze the risk factors for neonatal cerebral injury after FLOC and the factors influencing general developmental quotient score at the corrected age of 12 months. Chi-square test, t-test, and Mann-Whitney U test were used for statistical analysis. Results:(1) The perinatal mortality rate in the FLOC group was lower than that in the non-FLOC group [14.7% (20/136) vs 26.1% (23/88), χ 2=4.50, P=0.034]. There was no statistical significance in the incidence of neonatal cerebral injury between the two groups [18.7% (23/123) vs 21.8% (17/78), χ 2=0.29, P=0.592], but the incidence of severe cerebral injury in the FLOC group was lower than that in the non-FLOC group [6.5% (8/123) vs 15.4% (12/78), χ 2=4.20, P=0.040]. (2) In the FLOC group, there was no significant difference in the incidence of cerebral injury between donors and recipients, or between Solomon surgery and selective laser surgery [16.4% (10/61) vs 21.0% (13/62), χ 2=0.42; 20.0% (9/45) vs 17.9% (14/78), χ 2=0.08; both P>0.05]. (3) Multivariate analysis showed that neonatal asphyxia ( OR=7.04, 95% CI: 1.45-34.20, P=0.016) and higher preoperative TTTS stage ( OR=2.05, 95% CI: 1.10-3.82, P=0.023) were risk factors for neonatal cerebral injury. (4) Fifty-two cases were successfully followed up at the corrected age of 12 months, and the incidence of developmental delay in at least one dimension was 34.6% (18/52). Developmental delay was mainly manifested in locomotor skills and language, accounting for 26.9% (14/52) and 11.5% (6/52). No significant difference in Z value was found between recipients and donors in each dimension (all P>0.05). Solomon surgery, larger gestational age at operation and low birth weight were related to low general developmental quotient score (95% CI:－11.71 to－0.23，－1.99 to－0.47，0.00-0.01，respectively，all P<0.05). Conclusions:The occurrence of cerebral injury in TTTS survivors after FLOC is related to preoperative TTTS staging and intrapartum neonatal asphyxia. Neurodevelopment of survivors is related to birth weight and gestational age at surgery, and there is a higher incidence of mild developmental delay at corrected age of 12 months.

ObjectiveTo investigate effect of conducting training of autism spectrum disorder （ASD） early screening skill on improving the ability to early identify ASD of medical staffs in primary care hospitals. MethodsIn September 2021， the training of ASD early screening skills was carried out for medical staffs from 20 primary care hospitals in Chengdu. After training， the training effect was evaluated. The numbers of referrals from primary care hospitals to superior hospitals， confirmed ASD as well as their average diagnostic age of children with ASD before and after training were used as evaluation indicators. ResultsAfter training， the number of children with suspected ASD referred by primary care hospitals was more than that before training ［（16.65±11.60） vs. （3.40±2.23）， t=5.431， P<0.01］， the number of children diagnosed with ASD was more than that before training［（6.85±4.93） vs. （2.45±1.67）， t=4.171， P<0.01］， and the differences were statistically significant. As for the diagnosed age of ASD children， after training， the average age was lower than that before training ［（34.95±11.67） vs. （42.2±14.64）， t=-2.553， P=0.019］. ConclusionTraining of ASD early screening skills for medical staffs in primary care hospitals may help to improve their ability to early screening ASD children.

Objective:To investigate the current situation of children′s awareness of disaster prevention and self-rescue ability in Mianyang area, provide reference for the development of scientific training programs on children′s disaster knowledge, and improve children′s survival ability during the disaster occurence.Methods:Through literature review and expert consultation, the questionnaire was designed by ourselves.Multi-stage sampling method was used to investigate 2 162 cases from county (city) high school, junior high school and primary school in Mianyang area.Results:8.3% of children had weak disaster awareness.Children had a good understanding of disaster related knowledge, with the highest alarm call awareness rate of 91.8%, fire, flood, earthquake escape and earthquake warning score of 86.5%, 84.2%, 84.2%, 83.0%.Cardiopulmonary resuscitation and fire hydrant operation awareness rate was very low (58.8%, 57.4%). Even some children still chose improper escape behavior.The scores of early warning knowledge and first aid skill were correlated with gender and age.In knowledge of disaster precursors, using of fire extinguishers and hydrants, and first aid skills, the scores of boys were significantly higher than those of girls ( P<0.001). Except for fire-related knowledge, gas leakage escape and shelter awareness rate, the older the children were, the higher the scores were ( P<0.05). The scores of early warning, escape knowledge and first aid skills were correlated with the location of home, and the differences were significant ( P>0.001). More than 80.0% of children chose flashlights, food and water, and emergency kits, while 65.0% to 75.0% children thought it was not necessary to prepare a radio, telephone directory, and cash. Conclusion:Children′s awareness of disaster reduction and self-rescue ability are generally good, but there are still insufficient first-aid skills and improper choice of escape behavior.The education of disaster awareness and self-rescue ability should be strengthened in children′s basic education so as to reduce the casualties of children caused by disasters.

Objective To assess the safety and feasibility of video electroencephalographic (VEEG) monitoring in preterm infants and critically ill neonates in neonatal intensive care unit (NICU). Method From December 2017 to June 2018, high risk infants were prospectively enrolled and received VEEG monitoring in our NICU. Their basic information, adverse events and disturbances of any procedure during VEEG monitoring were collected by specially-trained nurses. Result A total of 245 times of VEEG were recorded. The average gestational age (GA) was (32.1 ± 3.6) weeks, the birth weight (BW) was (1879 ± 757) g, the corrected GA (cGA) at VEEG monitoring was (33.8±3.3) weeks, and the average weight at VEEG monitoring was (2008±716) g. The earliest cGA at VEEG monitoring was 25+5 weeks, and the lowest weight at VEEG monitoring was 520 g. The average monitoring duration was (4.9±2.4) h, ranging from 3 to 20 hours. During VEEG monitoring, 80 cases (32.7％) received noninvasive ventilation, 43 cases (17.6％) mechanical ventilation. The adverse events during electrodes placement were oxygen desaturation in 8(3.3％) cases. During VEEG monitoring, local skin erythema were found in 4 cases (1.6％), and electrodes displacement in 2(0.8％) cases. The disturbances of any clinical procedures were reported in 18(7.3％) cases. No severe adverse events such as displacement of endotracheal tube nor events requiring cardiopulmonary resuscitation occurred during VEEG monitoring. Conclusion It is feasible and safe for trained NICU nurses to place electrodes for high risk neonates.

Objective: By detecting the expression of interleukin-13 (IL-13) and periostin in the airway of asthmatic patients, the pathological changes and pulmonary functions of airway tissues in asthmatic patients were evaluated, and the role of IL-13 and periostin airway remodeling in bronchial asthma was preliminarily explored. Methods: The bronchial tissues adjacent to tumor nest were obtained from 12 patients with lung cancer complicated with bronchial asthma (asthmatic group) and 12 lung cancer patients without bronchial asthma (non-asthmatic group) after lung cancer resection. Pulmonary function was measured for all subjects before surgery. Pathological changes of airway tissues and degree of airway remodeling were assessed by hematoxylin-eosin (H&E) staining, masson′s trichrome staining, and periodic acid-silver methenamine (PASM) staining of paraffin-embedded sections. The expression of IL-13 and periostin in bronchial tissues were evaluated by immunohistochemistry. Results: Values of the forced expiratory volume in 1 second of the predicted value (FEV1% pred) and FEV1/forced vital capacity (FEV1/FVC%) in asthmatic patients were significantly decreased compared with the non-asthmatic patients (P<0.05), indicating that lung function was impaired in asthmatic patients. There was more severe airway remodeling representing as thickening of basement membranes, collagen deposition, and increasing of goblet cells and fibroblasts in asthmatic patients than in non-asthmatic patients (all P<0.05). The expression of IL-13 and periostin were higher in asthmatic tissues than in non-asthmatic tissues (P<0.05). The immunohistochemical expression of IL-13 and periostin in bronchial tissues were positively correlated with the degree of airway remodeling in asthmatic patients, and the expression of IL-13 and periostin in bronchial tissues were positively correlated with each other. Conclusions The expression of IL-13 and periostin were increased in bronchial tissue in patients with asthma. They work together to promote the occurrence of airway remodeling, which eventually lead to a decline in lung function.

ABSTRACT:Objective To summarize nursing experience of 45 complex renal calculi patients treated with invasive percutaneous nephrolithotomy of Cyberwand dual catheters.Methods Oxy-gen-inhaling and electrocardiograph monitoring were given to 45 patients and changes of disease were observed.The indwelling catheters were closely observed and were maintained unobstructed, and the color and property were observed.The related complications such as secondary hemorrhage and urinary irritation were controlled.Results All patients were successfully discharged after re-covery,among whom there was 1 case with postoperative septic shock,3 cases with secondary bleeding,and 3 cases with secondary nephrolithotomy,and all the patients were recovered they were followed after corresponding measures.After 6 ~24 months after operation,42 patients re-turned to normal and 3 cases maintained the former status without residue and relapse of stone. Conclusion Invasive percutaneous nephrolithotomy of Cyberwand dual catheters is safety and effec-tive,and postoperative nursing plays very important role in recovery of patients.

ABSTRACT:Objective To summarize nursing experience of 45 complex renal calculi patients treated with invasive percutaneous nephrolithotomy of Cyberwand dual catheters.Methods Oxy-gen-inhaling and electrocardiograph monitoring were given to 45 patients and changes of disease were observed.The indwelling catheters were closely observed and were maintained unobstructed, and the color and property were observed.The related complications such as secondary hemorrhage and urinary irritation were controlled.Results All patients were successfully discharged after re-covery,among whom there was 1 case with postoperative septic shock,3 cases with secondary bleeding,and 3 cases with secondary nephrolithotomy,and all the patients were recovered they were followed after corresponding measures.After 6 ~24 months after operation,42 patients re-turned to normal and 3 cases maintained the former status without residue and relapse of stone. Conclusion Invasive percutaneous nephrolithotomy of Cyberwand dual catheters is safety and effec-tive,and postoperative nursing plays very important role in recovery of patients.

Objective To compare different nursing methods impacting on the wound healing effects of circumcision for patients with Chinese Shang ring circumcision. Methods A total of 144 male patients with Chinese Shang ring circumcision were randomly divided into A and B group by coin tossing. The patients of A group received circumcised dressing to wrap wound with dressing change 3 times/week;the patients of B group had no dressing for wound to exposure wound and keep wound dry. Followed interviewed 2 months after operation, we compared the incision edema, the infection, rate of incision rupture, postoperative pain, wound healing time, satisfaction of incision appearance and so other indexes between two groups. Results The patients in the group B suffered less pain when erected in 2 weeks after operation (P<0. 05). The length of healing time in B group was (25.9 ±4.7) d, shorter than (27.8 ±5.0) d in the group A (P<0.05). The postoperative incision edema, incision rupture, infection and satisfaction of incision appearance were no statistical significance between two groups (P>0. 05). Conclusions To exposure the incision and keep it dry after Chinese Shang ring circumcision can minimize the level of pain and length of wound healing, and is worthy to promote.

An investigation of inappropriate feeding behavior and its impact was conducted in patents of 875 infants and toddlers aged 1-24 months from March 2004 to February 2008.The survey revealed that inappropriate feeding behavior included feeding sugar solution or sweet fruits daily in 72.1％ parents (631/875) ; adding yolk as the first supplementary food in 51.3％ (394/768) ; not allowing handgrabbing food or coarse food for infants over 7 months in 50.4％ (270/536) and 44.0％ (236/536) ; no meat eating for infants over 12 months in 36.0％ (54/150).And also revealed that 34.0％ (270/795) and 24.8％ (184/743) parents mixed rice flour or yolk with formula milk,respectively; 17.6％ (48/273) infant over 10 months only had cereal; insufficient or excessive water were used for reconstituting milk powder in 11.8％ (87/735) and 9.3％ (68/735),respectively.The results of investigation indicate that inappropriate feeding behavior among infants and toddlers are quite common and the reasons are various.