Objective To explore risk factors of sodium-dependent glucose transporters 2 （SGLT2） inhibitor-associated euglycemic diabetic ketoacidosis （euDKA） and to construct a risk prediction model. Methods A retrospective analysis was performed on the clinical data of type 2 diabetes patients treated with SGLT2 inhibitors in Dongnan Hospital of Xiamen University from January 2020 to December 2023, including age, gender and course of diabetes. The risk factors of SGLT2 inhibitor-associated euDKA were analyzed by univariate analysis and multivariate Logistic regression, and a prediction model was established. According to the receiver's operating characteristic （ROC） curve, the area under the curve （AUC） and the optimal critical value of the prediction model were determined. The prediction model was subjected to both internal and external validation. Results A total of 119 patients with type 2 diabetes treated with SGLT2 inhibitors were included in this study. Among them, there were 98 cases without euDKA （non-euDKA group）and 21 cases with euDKA （euDKA group）. Multivariate Logistic regression analysis showed the DKA history (OR=114.153), appetite or diet decreased three days before admission (OR=21.774), elevated neutrophil count (OR=2.056) and pre-hospital adjustment of hypoglycemic agents (OR=45.745) were independent factors to increase risks of euDKA associated with SGLT2 inhibitors （P<0.05）. Surgical history before admission was an independent factor to reduce this risk （OR=0.007, P<0.05）. By establishing the calculation formula of the prediction model = neutrophil count+6.571 （DKA history）−6.874 （surgical history before admission）+4.273 （appetite or diet decreased three days before admission）+5.302 （pre-hospital adjustment of hypoglycemic drugs）, the ROC curve was drawn. The AUC of the ROC of the prediction model was 0.982 （95%CI: 0.961-1.000, P<0.001）, with accuracy of 94.96%, sensitivity of 0.905, specificity of 0.959 and a critical value of 7.405. The AUC of ROC curve after the model’s ten-fold cross validation was 0.930. And the accuracy of the external validation of the prediction model was 85.29%. Conclusion The DKA history, appetite or diet decreased three days before admission, elevated neutrophil count and pre-hospital adjustment of hypoglycemic agents increased the risk of SGLT2 inhibitor-associated euDKA, while the surgical history before admission reduced this risk. The risk prediction model constructed on this basis could better predict the risk of SGLT2 inhibitor-associated euDKA.

Objective:To explore the influencing factors of prognosis in children with chronic urticaria treated with cetirizine and desloratadine in combination,and to construct a column chart prediction model.Methods:A total of 182 children with chronic urticaria who underwent cetirizine combined with desloratadine treatment in Hainan Women and Children's Medical Center from January 2019 to December 2021 were selected as study subjects for a one-year follow-up.They were divided into a relapse group(n=51)and a non relapse group(n=131)based on prognosis.Compared the medical records of two groups of children,and conducted independent sample t-test and χ2 to analyze the relevant indicators that affect the recurrence of chronic urticaria in children treated with cetirizine and desloratadine in combination;using MedCalc software,ROC curve analysis was conducted on statistically significant econometric indicators to explore their predictive value for recurrence in children with chronic urticaria treated with cetirizine and desloratadine in combination;independent risk factors for recurrence in children with chronic urticaria after combined use of cetirizine and desloratadine were analyzed by logistic regression analysis;R language software 4.0"rms"package was used to construct a column chart prediction model for the recurrence of chronic urticaria in children after the combination of cetirizine and desloratadine.Column chart prediction model was internally validated and evaluated for clinical predictive efficacy through calibration curve and decision curve.Results:Differences between the two groups of children were statistically significant(P<0.05)in terms of disease duration,history of previous allergic diseases,frequency of attacks,number of wind clusters,duration of wind clusters,mean diameter of wind clusters,IgE,IFN-γ,IL-10,IL-18 and CRP.AUCs for disease duration,episode frequency,number of wind clusters,duration of wind clusters,mean diameter of wind clusters,IgE,IFN-γ,IL-10,IL-18 and CRP were 0.854,0.697,0.739,0.876,0.847,0.767,0.902,0.804,0.829 and 0.850,respectively,and the best cutoff values were 8 months,4 times/week,6,3 h,2.1 cm,149.7 U/ml,27.2 ng/L,3.6 ng/L,40.5 ng/L,2.6 mg/L.Disease duration,IgE,IFN-γ,IL-10,IL-18 and CRP were independent risk factors affecting relapse after cetiri-zine and desloratadine combination in children with chronic urticaria.Calibration curve of the column chart prediction model was closed to the original curve and the ideal curve with a C-index of 0.625(95%CI:0.613～0.702),and the model fit was good;the threshold value of column chart prediction model was>0.16,which could provide a net clinical benefit,and all of the net clinical benefits were higher than those of disease duration,IgE,IFN-γ,IL-10,IL-18 and CRP.Conclusion:This study is based on the inde-pendent risk factors for recurrence in children with chronic urticaria after combined use of cetirizine and desloratadine,including course of disease,IgE,IFN-γ,IL-10,IL-18 and CRP,which have constructed a column chart prediction model to provide reference for the recurrence prediction of children with chronic urticaria,in order to screen high-risk recurrent children as soon as possible and take intervention measures to improve the recurrence situation and quality of life in children with chronic urticaria.

Objective:To explore the influencing factors of prognosis in children with chronic urticaria treated with cetirizine and desloratadine in combination,and to construct a column chart prediction model.Methods:A total of 182 children with chronic urticaria who underwent cetirizine combined with desloratadine treatment in Hainan Women and Children's Medical Center from January 2019 to December 2021 were selected as study subjects for a one-year follow-up.They were divided into a relapse group(n=51)and a non relapse group(n=131)based on prognosis.Compared the medical records of two groups of children,and conducted independent sample t-test and χ2 to analyze the relevant indicators that affect the recurrence of chronic urticaria in children treated with cetirizine and desloratadine in combination;using MedCalc software,ROC curve analysis was conducted on statistically significant econometric indicators to explore their predictive value for recurrence in children with chronic urticaria treated with cetirizine and desloratadine in combination;independent risk factors for recurrence in children with chronic urticaria after combined use of cetirizine and desloratadine were analyzed by logistic regression analysis;R language software 4.0"rms"package was used to construct a column chart prediction model for the recurrence of chronic urticaria in children after the combination of cetirizine and desloratadine.Column chart prediction model was internally validated and evaluated for clinical predictive efficacy through calibration curve and decision curve.Results:Differences between the two groups of children were statistically significant(P<0.05)in terms of disease duration,history of previous allergic diseases,frequency of attacks,number of wind clusters,duration of wind clusters,mean diameter of wind clusters,IgE,IFN-γ,IL-10,IL-18 and CRP.AUCs for disease duration,episode frequency,number of wind clusters,duration of wind clusters,mean diameter of wind clusters,IgE,IFN-γ,IL-10,IL-18 and CRP were 0.854,0.697,0.739,0.876,0.847,0.767,0.902,0.804,0.829 and 0.850,respectively,and the best cutoff values were 8 months,4 times/week,6,3 h,2.1 cm,149.7 U/ml,27.2 ng/L,3.6 ng/L,40.5 ng/L,2.6 mg/L.Disease duration,IgE,IFN-γ,IL-10,IL-18 and CRP were independent risk factors affecting relapse after cetiri-zine and desloratadine combination in children with chronic urticaria.Calibration curve of the column chart prediction model was closed to the original curve and the ideal curve with a C-index of 0.625(95%CI:0.613～0.702),and the model fit was good;the threshold value of column chart prediction model was>0.16,which could provide a net clinical benefit,and all of the net clinical benefits were higher than those of disease duration,IgE,IFN-γ,IL-10,IL-18 and CRP.Conclusion:This study is based on the inde-pendent risk factors for recurrence in children with chronic urticaria after combined use of cetirizine and desloratadine,including course of disease,IgE,IFN-γ,IL-10,IL-18 and CRP,which have constructed a column chart prediction model to provide reference for the recurrence prediction of children with chronic urticaria,in order to screen high-risk recurrent children as soon as possible and take intervention measures to improve the recurrence situation and quality of life in children with chronic urticaria.

Objective To explore risk factors of poor early prognosis in the treatment of COVID-19 by nematevir and ritonavir tablets Paxlovid and establish the prediction model to provide reference for improving the effect of such patients. Methods 92 inpatients of COVID-19 treated with Paxlovid in three military tertiary hospital in southern Fujian from January 2023 to March 2023 were retrospectively analyzed. The clinical indicators of 92 inpatients were collected for univariate and multivariate analysis by single factor and multiple factors and the independent risk factors of poor early prognosis in Paxlovid were screened out. Logistic model equation was transformed to construct the combined predictors, and ROC curve was used to determine the area under the curve (AUC) and the optimal critical value of the combined predictors. Results Among 92 patients, 31 (33.70%) developed poor early prognosis, including 11 deaths (35.48%), 17 critical cases (54.84%) and 3 severe cases (9.68%). Multi-factor Logistic regression analysis showed that the disease days, lymphocyte count, aspartate aminotransferase(AST), C reactive protein(CRP) and ventilator-assisted ventilation were independent risk factors for poor early prognosis in Paxlovid. A formula for calculating the combined predictors (Y) was established as Y_{combinedpredictors}=7.875X_{disease days}+126.188X_{lymphocyte count}+1.438X_AST+X_CRP+220.500X_{ventilator-assisted ventilation} based on the above independent risk factors, and the ROC curve was drawn. With the maximum area under the ROC curve of the combined predictors being 0.939, the prediction value was best, and the optimal critical value of the ROC curve corresponding to the maximum Youden index (0.756) was 447.920.Theoretical accuracy of the model was 89.10%. Conclusion The disease days, lymphocyte count, AST, CRP and ventilator-assisted ventilation were independent risk factors for poor early prognosis in Paxlovid. Combined predictors could be calculated by the above risk factors before medication. The efficiency should be improved by taking more active treatment, including combining with other anti-COVID-19 drugs when the prediction result exceeds 447.920.

Objective:To observe the effect of early weight-bearing on the appropriate population with intertrochanteric fracture after surgery. Methods:From April, 2017 to December, 2018, a total of 45 patients with Evans-Jensen type II intertrochanteric fracture and fracture reduction as positive medial cortex support (PMCS) after proximal femoral nail anti-rotation (PFNA) fixation were randomly divided into control group (n = 22) and experimental group (n = 23). Weight-bearing as tolerated (WBAT) was initiated from six weeks after surgery in the control group, and within 48 h after surgery in the experimental group. The frequency of WBAT in two groups increased gradually from three times a day for ten minutes a time to five times a day for 20 minutes a time until clinical healing of fracture. The length of stay, hospital cost, the fracture healing time and the complication incidence were compared between two groups, as well as the scores of Visual Analogue Scale (VAS) and Harris Hip Score at six weeks, three months and six months after surgery. Results:Compared with the control group, the length of stay was shorter (t = 3.716, P < 0.01), the hospital cost was lower, but no significant difference was found (t = 1.540, P > 0.05), and the fracture healing time was shorter (t = 6.248, P < 0.001) in the experimental group. The complication incidence was lower in the experimental group, but there was no significant difference (χ²= 2.198, P > 0.05). Six weeks, three months and six months after surgery, there was no significant difference in the score of VAS between two groups (t < 1.330, P > 0.05). The score of Harris Hip Score was significantly higher in the experimental group than in the control group six weeks after surgery (t = -5.115, P < 0.001), however, no significant difference was found in other time points (|t| < 1.799, P > 0.05). Conclusion:Early weight-bearing within 48 h after PFNA fixation for Evans-Jensen type II intertrochanteric fractures and reduction with PMCS could shorten the length of stay, shorten the bony healing time and promote early recovery of hip function.

Objective To detect the change of exoression level of plasma microRNA‐21(miR‐21) and TGF‐β1 in cardiac remode‐lin affer acute myocardial infarction(AMI) of the pateins .Methods 200 pateints with AMI and 100 normal controls(age ,sex matched) were enrolled .Blood samples were obtained from the normal controls and patients with AMI on the 3 days ,7 days and 14 days .Real‐time PCR was developed to detect the expression of miR‐21 and TGF‐β1 in plasma .Results The expression of miR‐21 was significantly up‐regulation in the 3 days ,7 days and 14 days in MI group than that cntrol group ,0 .74 ± 0 .21 vs .2 .62 ± 0 .23 , vs .3 .67 ± 0 .25 ,vs .4 .13 ± 0 .27 up‐regulation in the 3 days ,7 days and 14 days in MI group than that cntrol group ,0 .98 ± 0 .18 vs .2 .35 ± 0 .24 ,vs .3 .67 ± 0 .25 ,vs .4 .13 ± 0 .27 ,P<0 .05 ,respectively .The expression of miR‐21 and TGF‐β1 were up‐regulation with the change of cardiac function .Positive relationship between miRNA‐21 expression and LVDd (r=0 .757 ,P<0 .05);Positive relationship between TGF‐β1 mRNA expression and LVDd(r=0 .701 ,P<0 .05) .Conclusion The expression of miR‐21 and TGF‐β1 were up‐regulation in cardiac remodelin affer AMI of the pateins ,which involved in regulation in cardiac remodelin affer AMI .

OBJECTIVETo evaluate the feasibility and safety of the modified urethral pull-through procedure for the treatment of posterior urethral stricture or atresia.

METHODSWe retrospectively analyzed 212 cases of posterior urethral stricture or atresia treated by the modified urethral pull-through procedure. The length of the stricture or atresia was 1.5 - 12 cm, and 66 cases had experienced 1 - 4 previous unsuccessful urethral repairs. Simple transperineal approach was adopted in 208 cases and transperineal-inferiorpubic approach in the other 4. And 15 of the patients underwent urethral construction with grafts.

RESULTSSatisfactory voiding was achieved in 198 (93.4%) of the patients, of whom 16 received 3 - 15 urethral dilations. Of the 14 cases that failed, 10 succeeded after a second and 2 after a third operation. Of the 15 cases that underwent substitution urethroplasty, 14 achieved satisfactory voiding, and only 1 needed repeat dilation. No serious complications were observed in any of the patients.

CONCLUSIONModified urethral pull-through procedure, with its advantages of safety, mini-invasiveness, simple operation and high success rate, is feasible for the treatment of posterior urethral stricture or atresia, while for that with the length >5 cm, substitution urethroplasty should be considered.

Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urethra ; surgery ; Urethral Stricture ; surgery ; Urologic Surgical Procedures ; methods ; Young Adult