Objective To investigate the factors influencing the development of extra-pulmonary tuberculosis(EPTB)in patients with viral hepatitis complicated by pulmonary tuberculosis(PTB).Methods A retrospective analysis was conducted on 427 patients with Hepatitis B Virus(HBV)and Hepatitis C Virus(HCV)infections complicated by PTB admitted to the tuberculosis department of Kunming Third People's Hospital from January 2015 to December 2020.Patients were divided into the EPTB complication group(n=72)and the non-EPTB complication group(n=355)based on the presence of EPTB.Clinical treatment data of patients were collected.Univariate and multivariate Logistic regression analyse were used to screen independent risk factors for EPTB as predictive factors.A nomogram prediction model was established for Extrapulmonary Tuberculosis(EPTB)complications in patients with viral hepatitis and Pulmonary Tuberculosis(PTB),evaluated using the Hosmer-Lemeshow test and ROC curve analysis.Results Among the 427 patients,292(68.3%)were male and 135(31.7%)were female,with 72 cases of EPTB,resulting in an incidence rate of 16.86%.In the EPTB group,there were 34 males(47.2%)and 38 females(52.8%).The types of EPTB included tuberculous pleuritis(21 cases,29%),tuberculous peritonitis(16 cases,22%),lymph node tuberculosis(13 cases,18%),tuberculous encephalitis(5 cases,6%),intestinal tuberculosis(6 cases,8%),bone tuberculosis(5 cases,6%),pelvic tuberculosis(3 cases,4%),and genitourinary tuberculosis(3 cases,4%).Multivariate logistic regression analysis showed that gender(OR=0.425,95%CI:0.250-0.722,P=0.02),low triglyceride(TG)levels(OR=0.837,95%CI:0.717-0.978,P=0.025),the tuberculosis-specific antigen A(ESAT-6)(OR=1.007,95%CI:1.003～1.011 were independent influencing factors for EPTB in patients with PTB complicated by HBV and HCV infections.The optimal cutoff value for the nomogram model is 0.192,with a sensitivity of 0.611,specificity of 0.710,Youden index of 0.741,positive likelihood ratio of 2.103,and negative likelihood ratio of 0.548.The Hosmer-Lemeshow test yielded χ2=2.631,P=0.955.ROC curve analysis showed an AUC of 0.693,95%CI:0.629 1～0.7574.Conclusion The prediction model based on gender,low TG levels and ESAT-6 can well predict the occurrence of EPTB to some extent,providing a reference for clinical treatment.

Objective To evaluate the relationship between nutritional parameters and the risk of venous thromboembolicism(VTE)in patients with tuberculosis so as to identify the risk factors and predictors of thrombosis and assist in the early identification of high-risk factors for VTE in patients with the pulmonary tuberculosis.Methods A total of 323 patients diagnosed with the pulmonary tuberculosis and hospitalized in Kunming Third People's Hospital from August 2021 to August 2023 were collected.According to the VTE risk assessment of non-operative patients,they were divided into the high-risk group and the low-risk group respectively with 116 and 207 in each group.The nutritional indicators with statistically significant differences between the two groups were screened by Lasso regression.Multivariate Logistic regression was used to screen the independent risk factors for high VTE risk in pulmonary tuberculosis patients,and a nomogram prediction model was constructed.The prediction model was evaluated by receiver operating characteristic curve(ROC),calibration curve,decision curve,and influence curve.Results Patients in the high-risk group were significantly older than those in the low-risk group(59 vs.41,P<0.001),hypertension,gender,and Type 2 diabetes did not differ significantly(P values were 0.084,0.724 and 0.488,respectively).9 variables were selected from the inter-group comparison and Lasso regression,including ALB,HCT,NRS2002 scores,HBDH,RDW-SD,RDW-CV,TG,CONUT scores,and NEFA.Multivariate Logistic regression analysis showed that ALB,NRS2002 scores,RDW-SD,and CONUT scores were independent influencing factors for the high risk of VTE scores in patients with tuberculosis(P<0.005).Area under the ROC curve showed that the AUC(0.892)for high-risk VTE scores in patients with the pulmonary tuberculosis was greater than that of ALB(0.803),NRS2002 score(0.735),RDW-SD(0.685),and CONUT score(0.774).Fitting prediction model:Logit(P):Y=0.433×NRS-0.136×ALB+0.411×CONUT score+0.072×RDW-SD-1.770,P=1/(1+e-Y)(Y:prediction index,P:prediction probability).Calibration curve showed that the model prediction tended to be consistent with the actual results(U:>0.05),and the decision curve and influence curve showed that the model can bring clinical benefits.Conclusion ALB,NRS2002 scores,RDW-SD,and CONUT scores are independent influencing factors for the high risk of VTE scores in patients with tuberculosis.They can guide the clinical practice,improve these indicators as soon as possible,reduce VTE scores,and reduce the thrombosis risk.At the same time,the prediction model performs well in the verification cohort,with its discrimination ability,calibration accuracy and clinical utility(decision curve analysis)all reaching a satisfactory level.

Objective To investigate the effects of long noncoding RNA(lncRNA)-NRON on apoptosis following myocardial infarc-tion(MI)in mice.Methods The C57BL/6 mice were randomly divided into four groups:sham operation(Sham)group,MI group,MI combined with lncRNA-NRON interference lentivirus(MI+shNRON)group,and MI combined with the negative control(NC)lentivirus(MI+NC)group.The expression of lncRNA-NRON was detected using real-time PCR.In addition,the pathology of the myocardial tissue injury was analyzed using HE staining,the myocardial infarction size was examined using TTC staining,and the extent of apoptosis was assessed using the TUNEL assay,respectively.The RPISeq database was used to predict the probability of interaction between lncR-NA-NRON and the voltage-dependent anionic channel protein(VDAC).The effect of lncRNA-NRON on the expression of VDAC protein was detected using Western blotting.Results The lncRNA-NRON expression was significantly increased in the MI group,and the tar-geted knockdown of lncRNA-NRON resulted in alleviation of the pathological myocardial tissue injury,reduction in the myocardial infarc-tion area,and inhibition of apoptosis.The probability of interaction between lncRNA-NRON and VDAC reached 0.9,indicating a high probability of their association.Additionally,lncRNA-NRON could regulate the protein expression of VDAC.Conclusion Knockdown of lncRNA-NRON could reduce the occurrence of myocardial injury following myocardial infarction.This effect may be attributable to a spe-cific mechanism wherein lncRNA-NRON affects the process of apoptosis by binding to VDAC,consequently suppressing its expression.

Objective To compare the consistency of liquid chromatography-tandem mass spectrometry(LC-MS/MS)and fully auto-mated chemiluminescent immunoassay(CLIA)methods in measuring plasma aldosterone concentration(PAC)in the elderly patients in intensive care unit(ICU)and to explore the correlation between the levels of aldosterone(ALD)and blood biomarkers.Methods A total of 41 elderly ICU patients were included.PAC was measured using both LC-MS/MS and CLIA methods,followed by methodolo-gy validation and consistency comparison.Meanwhile,a retrospective analysis of the patients'clinical data was conducted,and the cor-relations between ALD and blood biomarkers were analyzed.Results The linear range of the LC-MS/MS method was 15 to 1 500 pg/mL,with a lower limit of quantification of 15 pg/mL.The inter-day and intra-day precisions were both less than 15％,and the re-covery rate was 94％to 99％,with no significant matrix effect.The PAC results detected by CLIA and LC-MS/MS methods were posi-tively correlated(r=0.762 7,P＜0.01),but the consistency between the two methods was poor.Deming regression analysis yielded the equation Y=0.969 6X-16.71,with a slope of 0.970(95％CI:0.890～1.049)and an intercept of-16.71(95％CI:-25.690 to-7.728).Bland-Altman analysis showed that CLIA overestimated PAC by an average of 21.18 pg/mL(95％CI:-25.89 to 68.26 pg/mL)compared to LC-MS/MS,with a bias of 24.02％.In the correlation analysis between ALD and blood biomarkers,ALD showed a significant positive correlation with myoglobin(Mb)(r=0.303,P＜0.05).Conclusion The LC-MS/MS method demonstrated good methodological performance in measuring PAC in the elderly patients in ICU.The consistency between LC-MS/MS and CLIA methods was poor,and the two methods should not be used interchangeably in clinical practice.There was a positive correlation between ALD and Mb,suggesting that ALD may be associated with myocardial injury.

OBJECTIVE To compare the safety of high-dose methotrexate （HD-MTX） via peripherally inserted central catheter （PICC） and totally implantable venous access port （TIVAP） in pediatric patients with malignant brain tumors. METHODS Patients with malignant brain tumors who received HD-MTX via PICCs or TIVAPs in our hospital from July 2018 to April 2022 were retrospectively analyzed. Clinical data were collected to compare differences in blood concentration of methotrexate （MTX），the incidence of adverse events （including adverse drug reactions and catheter-related complications） and length of stay in hospital. Multivariate linear regression was applied to analyze the factors that influenced the blood concentration of MTX. RESULTS A total of 107 patients were included in the study，with 65 patients in the PICC group and 42 patients in the TIVAP group. Blood concentration of MTX at 24 h （C24 h） in TIVAP group was significantly higher than PICC group （[ 126.87±61.99） μmol/L vs. （102.45±48.77） μmol/L，P＜0.05）. There was no significant difference in blood concentration of MTX at 42 h （C42 h），compared with PICC group （P＞0.05）. Results of multivariate linear regression analysis showed that TIVAP was associated with the increase of C24 h（P＜0.05）. No significant differences were observed in the incidence of adverse events and the length of stay in the hospital between 2 groups （P＞0.05）. CONCLUSIONS Risk of adverse events is not increased，although the MTX C24 h level is elevated after administration of TIVAP. TIVAP is a safe choice for HD-MTX therapy with implementing therapeutic drug monitoring.

Objective:To evaluate the value of 18F-FDG PET/CT in the diagnosis and treatment of primary breast lymphoma (PBL). Methods:Clinical data and 18F-FDG PET/CT imaging data of 6 patients (all females, age 46-79 years) with pathologically diagnosed primary breast diffuse large B cell lymphoma (PB-DLBCL) in Xishan People′s Hospital of Wuxi City and Affiliated Hospital of Jiangnan University from July 2015 to October 2021 were analyzed retrospectively. A total of 10 18F-FDG PET/CT scans were done for primary staging (6 scans of 6 patients), evaluation of treatment response (3 scans of 2 patients), and recurrence detection (1 scan of 1 patient). 18F-FDG PET/CT image analysis was performed qualitatively (visually) and semi-quantitatively (SUV max). Treatment response was evaluated by Deauville scores. Results:All 6 patients were diagnosed pathologically as PB-DLBCL (3 patients by core needle biopsy, 3 patients by biopsy after lumpectomy). All 6 patients were staged using baseline 18F-FDG PET/CT before chemotherapy. For 3 patients diagnosed by core needle biopsy, baseline 18F-FDG PET/CT showed unilateral breast lesion with high FDG uptake (SUV max: 23.0, 52.9, and 33.6). For 3 postoperative patients, baseline 18F-FDG PET/CT showed flocculent soft tissue density in the operative area with low FDG uptake (SUV max: 3.4, 2.2 and 2.0). Patient No.2 showed a large left breast mass with left axillary lymph node involvement by baseline PET/CT, and multiple nodular uptakes in bilateral breast (Deauville score of 4) after 4 courses of chemotherapy and negative result (Deauville score of 1) after 3 courses of new chemotherapy regimens by PET/CT. Patient No.4 showed right breast lesion and right axillary lymph nodes by routine preoperative imaging examination, but left breast lesion by postoperative PET/CT. According to the results of 18F-FDG PET/CT, patient No.4 was with complete response (Deauville score of 1) after treatment, but recurrence (Deauville score of 5) occurred after 7 months follow-up. Conclusion:18F-FDG PET/CT can play an important role in every step of management (diagnosis and staging, treatment response evaluation and detection of recurrence) in patients with PB-DLBCL.

Objective:To explore the status quo of tolerance level of pediatric nurses, analyze the effect of self-efficacy, social support and coping style on tolerance and analyze its influence path.Methods:From February 2021 to April 2021, a total of 240 pediatric nurses from 3 ClassⅢ Grade A hospitals in Zhengzhou were selected as the research objects by the convenient sampling method. The Tolerance Scale, Self-Efficacy Scale, Social Support Rating Scale and Simple Coping Style Scale were used to investigate. The structural equation model was established using AMOS 22.0 software. A total of 240 questionnaires were distributed in this study, and 229 valid questionnaires were recovered, with an effective recovery rate of 95.42%.Results:The total score of Tolerance Scale of 229 pediatric nurses was (80.37±11.47) . The path analysis model showed that both positive and negative coping could directly affect tolerance, while self-efficacy and subjective support could not only directly affect tolerance, but also affected tolerance of pediatric nurses through mediating effect of positive and negative coping.Conclusions:Pediatric nurses have a high level of endurance. The higher the level of self-efficacy, the stronger the degree of subjective support, and the more positive coping styles, the higher the level of tolerance of pediatric nurses. Therefore, it is suggested that nursing managers should strengthen the training and education of self-efficacy, subjective support and positive coping styles of pediatric nurses, so as to further improve the tolerance level of pediatric nurses and improve the quality of nursing.

Objective To analyze the risk factors and pathogen distribution of nosocomial infection in adult patients undergoing extracorporeal membrane oxygenation (ECMO) after cardiac surgery.Methods The clinical data of 325 patients who underwent ECMO support in the Department of Adult Cardiac Surgery of Beijing Anzhen Hospital from January 2012 to December 2017 were retrospectively analyzed.There were 132 patients with nosocomial infection (infected group) and 193 patients without nosocomial infection (noninfected group).Multivariate logistic analysis was used to analyze the risk factors of nosocomial infection,and the distribution of pathogens in infected patients was also analyzed.Results Among 132 infected patients,67 cases (50.76％) had respiratory infection,40 cases (30.30％) had blood infection,15 cases (11.36％) had surgical wound infection,and 10 cases (7.58％) had urinary tract infection.The case fatality rates of the infected group and non-infected group were 61.37％ (81/132) and 52.85％ (102/ 193),respectively (x2 =6.356,P ＜ 0.05).Univariate analysis showed that long operation time,application of extracorporeal circulation and long-term ECMO support were associated with nosocomial infection.Multivariate logistic regression analysis found that ECMO time (OR =5.565,95％ CI =2.868-10.799,P ＜0.01) was an independent risk factor for nosocomial infection after ECMO treatment in adult patients after cardiac surgery.Among the 132 infected patients,364 strains of pathogens were detected,of which 233 were Gram-negative bacteria,including 79 strains of Acinetobacter Baumann (33.9％) and 32 strains of K.pneumoniae (13.73％);101 strains were Gram-positive bacteria,including Streptococcus aureus (14.85％),Micrococcus (14.85％) and catarrhal bacteria (14.85％);30 strains were fungi and Candida albicans accounted for 70％ of fungi infections.Conclusion The long ECMO support time is an independent risk factor for ECMO-related hospital infections in adult patients undergoing cardiac surgery,and the pathogens are mainly Gram-negative bacteria.

OBJECTIVE:To observe clinical efficacy and safety of Astragalus injection combined with neoadjuvant chemother-apy and three dimensional conformal radiotherapy in the treatment of colorectal cancer. METHODS:A total of 80 patients with me-dium and advanced colorectal cancer were selected from oncology department of our hospital during Jun. 2010 to Jun. 2014,and di-vided into observation group and control group according to random number table,with 40 cases in each group. Control group re-ceived neoadjuvant chemotherapy combined with three-dimensional conformal radiotherapy. Observation group was additionally giv-en Astragalus injection 10-20 mL added into 5％ Glucose injection 250-500 mL,ivgtt,qd,on the basis of control group. A treat-ment course lasted for 21 d,and both groups received 3 courses. Short-term efficacies as well as immune indexes [CD3+,CD4+, CD4+/CD8+ and NK cells] before and after treatment were observed in 2 groups. The occurrence of ADR and survival situation were compared between 2 groups. RESULTS:Clinical response rate of observation group was 87.5％,which was slightly higher than that of control group(77.5％),but there was no statistical significance(P>0.05). Before treatment,there was no statistical signifi-cance in immune index levels between 2 groups(P>0.05). After treatment,NK cells,CD3+,CD4+ and CD4+/CD8+ levels of con-trol group were decreased significantly,which was significantly lower than observation group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). Two-year survival rate of observa-tion group was significantly higher than that of control group;the recurrence rate and distant metastasis rate were significantly low-er than control group,with statistical significance(P<0.05). CONCLUSIONS:Astragalus injection not only can improve therapeu-tic efficacy of neoadjuvant chemotherapy in patients with colorectal cancer,balance inflammatory state,improve survival rate,re-duce recurrence rate and distant metastasis rate with good safety.

The vast majority of the published papers dealing with the treatment of wounds in the past few decades reported that extracorporeal shock wave therapy (ESWT) used in wound repair is easy in manipulation, noninvasive, safe, effective, and well tolerated by patients. However, little is known about the mechanism of ESWT in wound healing to date. In this article, we reviewed the literature to identify the potential cellular and molecular mechanisms of ESWT in the process of wound healing, and the results of the literature showed that the mechanism of ESWT in promoting wound healing is the result of heterogeneous biological effects.
High-Energy Shock Waves ; therapeutic use ; Humans ; Skin ; Soft Tissue Injuries ; therapy ; Ultrasonic Therapy ; methods ; trends ; Wound Healing ; physiology