Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To investigate the potential utility of the lymphocyte to monocyte ratio (LMR) and its modified index, albumin-LMR product, as predictive biomarkers for disease activity and presence of lupus nephritis in systemic lupus erythematosus (SLE).Methods:A total of 264 patients with newly diagnosed SLE who were treated at Henan Provincial People′s Hospital between December 2016 and September 2022 were included in this study. Their clinical data were subsequently collected for analysis. Patients were classified into non-active disease group (SLEDAI<5, n=55) and active disease group(SLEDAI≥5, n=209) based on the SLE SLEDAI. The Mann-Whitney U test was employed to compare the differences in clinical parameter levels, LMR and albumin-LMR product between the two groups. Additionally, the active disease group was further stratified into mild(SLEDAI 5~9, n=86), moderate(SLEDAI 10~14, n=96) and severe (SLEDAI≥15, n=27) subgroups to assess differences in LMR and albumin-LMR product. Further more patients were stratified into two groups based on renal involvement: those without lupus nephritis(non-LN) and those with lupus nephritis (LN). For non-parametric comparisons, the Mann-Whitney U test was used for intergroup comparisons between two groups, while the Kruskal-Wallis H test was applied for comparisons among three groups. If the Kruskal-Wallis H test revealed statistically significant differences ( P<0.05), pairwise comparisons were performed using the Mann-Whitney U test, and the significance level was adjusted using the Bonferroni method to account for multiple testing.Correlations between LMR, albumin-LMR product, and disease activity indicators were analyzed using Spearman′s correlation. The diagnostic value of LMR and albumin-LMR product for SLE activity was evaluated using the receiver operating characteristic (ROC) curves. Results:Both LMR and albumin-LMR product were significantly lower in active disease group compared to the non-active group {LMR:3.56 (2.15, 5.00) vs. 5.68 (3.89, 7.00); albumin-LMR product [93.21 (59.50, 143.98)g/L] vs. [187.89 (137.67, 260.90)]g/L, Z=-5.68, -7.05, P<0.001 for all}. Further subgroup analysis revealed that LMR and albumin-LMR product levels in severe, moderate, and mild active disease were also significantly decreased compared to the non-active disease group {LMR:3.83(1.78, 5.09)、3.09(2.06, 4.90)、3.65(2.45, 5.03) vs. 5.68(3.89, 7.00); albumin-LMR product: [95.69(66.57, 121.61)]g/L、[79.82(49.02, 126.91)]g/L、[104.73(69.21, 169.01)]g/L vs. [187.89(137.67, 260.90)]g/L, H=34.27, 58.29, P<0.001 for all}. A significant disparity in the levels of LMR and albumin-LMR product was detected between the non-LN and LN, with statistical significance ( Z=-3.44, P=0.001 and Z=-7.06, P<0.001). Correlation analysis indicated that LMR negatively correlated with SLEDAI( r=-0.31), urea( r=-0.29), creatinine ( r=-0.28) and 24-hour urinary protein level ( r=-0.27), all P<0.001, with no significant correlation to complement C3 or C4. Albumin-LMR product showed stronger negative correlations with SLEDAI ( r=-0.44), urea ( r=-0.40), creatinine ( r=-0.37), and 24-hour urinary protein ( r=-0.55), all P<0.001, and a positive correlation with complement C3 ( r=0.18, P=0.004). The areas under the ROC curves for LMR and LMR combined with complement C3 were 0.749 and 0.795, respectively, while for albumin-LMR product and its combination with complement C3, they were 0.809 and 0.833, indicating superior diagnostic efficacy for the modified albumin-LMR product. Conclusion:LMR and albumin-LMR product levels are significantly associated with SLE disease activity and may serve as potential biomarkers for assessing SLE activity and the degree of lupus nephritis.

Objective:To investigate the potential utility of the lymphocyte to monocyte ratio (LMR) and its modified index, albumin-LMR product, as predictive biomarkers for disease activity and presence of lupus nephritis in systemic lupus erythematosus (SLE).Methods:A total of 264 patients with newly diagnosed SLE who were treated at Henan Provincial People′s Hospital between December 2016 and September 2022 were included in this study. Their clinical data were subsequently collected for analysis. Patients were classified into non-active disease group (SLEDAI<5, n=55) and active disease group(SLEDAI≥5, n=209) based on the SLE SLEDAI. The Mann-Whitney U test was employed to compare the differences in clinical parameter levels, LMR and albumin-LMR product between the two groups. Additionally, the active disease group was further stratified into mild(SLEDAI 5~9, n=86), moderate(SLEDAI 10~14, n=96) and severe (SLEDAI≥15, n=27) subgroups to assess differences in LMR and albumin-LMR product. Further more patients were stratified into two groups based on renal involvement: those without lupus nephritis(non-LN) and those with lupus nephritis (LN). For non-parametric comparisons, the Mann-Whitney U test was used for intergroup comparisons between two groups, while the Kruskal-Wallis H test was applied for comparisons among three groups. If the Kruskal-Wallis H test revealed statistically significant differences ( P<0.05), pairwise comparisons were performed using the Mann-Whitney U test, and the significance level was adjusted using the Bonferroni method to account for multiple testing.Correlations between LMR, albumin-LMR product, and disease activity indicators were analyzed using Spearman′s correlation. The diagnostic value of LMR and albumin-LMR product for SLE activity was evaluated using the receiver operating characteristic (ROC) curves. Results:Both LMR and albumin-LMR product were significantly lower in active disease group compared to the non-active group {LMR:3.56 (2.15, 5.00) vs. 5.68 (3.89, 7.00); albumin-LMR product [93.21 (59.50, 143.98)g/L] vs. [187.89 (137.67, 260.90)]g/L, Z=-5.68, -7.05, P<0.001 for all}. Further subgroup analysis revealed that LMR and albumin-LMR product levels in severe, moderate, and mild active disease were also significantly decreased compared to the non-active disease group {LMR:3.83(1.78, 5.09)、3.09(2.06, 4.90)、3.65(2.45, 5.03) vs. 5.68(3.89, 7.00); albumin-LMR product: [95.69(66.57, 121.61)]g/L、[79.82(49.02, 126.91)]g/L、[104.73(69.21, 169.01)]g/L vs. [187.89(137.67, 260.90)]g/L, H=34.27, 58.29, P<0.001 for all}. A significant disparity in the levels of LMR and albumin-LMR product was detected between the non-LN and LN, with statistical significance ( Z=-3.44, P=0.001 and Z=-7.06, P<0.001). Correlation analysis indicated that LMR negatively correlated with SLEDAI( r=-0.31), urea( r=-0.29), creatinine ( r=-0.28) and 24-hour urinary protein level ( r=-0.27), all P<0.001, with no significant correlation to complement C3 or C4. Albumin-LMR product showed stronger negative correlations with SLEDAI ( r=-0.44), urea ( r=-0.40), creatinine ( r=-0.37), and 24-hour urinary protein ( r=-0.55), all P<0.001, and a positive correlation with complement C3 ( r=0.18, P=0.004). The areas under the ROC curves for LMR and LMR combined with complement C3 were 0.749 and 0.795, respectively, while for albumin-LMR product and its combination with complement C3, they were 0.809 and 0.833, indicating superior diagnostic efficacy for the modified albumin-LMR product. Conclusion:LMR and albumin-LMR product levels are significantly associated with SLE disease activity and may serve as potential biomarkers for assessing SLE activity and the degree of lupus nephritis.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To analyze the phenotype and genotype of congenital myasthenic syndrome type 10 (CMS10) caused by DOK7 gene mutation, and to conduct a literature review and summary of this disease. Methods:A retrospective analysis of the clinical characteristics and genetic test results of a patient with CMS10 in Affiliated Nanjing Brain Hospital, Nanjing Medical University in January 2020 was conducted. Whole exon sequencing was applied to high-throughput screen the pathogenic gene in this patient. After finding candidate variants, pathogenic classification was done according to the American College of Medical Genetics and Genomics and the Association for Molecular Pathology guideline. Sanger sequencing was applied to verify the mutation. Then all patients with DOK7 gene mutations were summarized by searching the literatures through PubMed, CNKI and Wanfang database. Results:The patient was a 51-year-old man who clinically presented with fluctuating quadriparesis and respiratory distress. He was diagnosed as CMS10 with compound mutations in DOK7 (c.1296_1311del16/c.332-1G>A) by clinical information and whole exon and Sanger sequencing. And c.332-1G>A was found to be a novel mutation. Literature review showed that patients with CMS10 with DOK7 gene mutations presented dominant weakness in proximal limbs and axial muscles. Patients with CMS10 would show periodic exacerbation in disease duration with slow progression. Among 71 mutations, frameshift mutation was the most frequent type (38.0%, 27/71), followed by missense mutation (32.4%, 23/71). Exon 7 (35.2%, 25/71) and exon 4 (26.8%, 19/71) were the hotspot regions. c.1124_1127dupTGCC was the most frequent mutation (43.2%, 140/324). The age of onset in patients with homozygous c.1124_1127dupTGCC was older than that in patients with compound heterozygous c.1124_1127dupTGCC [7.5(3.6, 19.8) years vs 1.3(0, 3.8) years, U=350.000, P<0.001]. Conclusions:CMS10 is a slowly progressive autosomal recessive genetic disease characterized by fluctuating muscle weakness, with muscle weakness distribution similar to limb-girdle muscular dystrophy. Frameshift mutation is the most common type in DOK7 gene associated CMS10. c.1124_1127dupTGCC in C-terminal is the most frequent mutation. Early identification of DOK7 gene associated CMS10 is crucial for the treatment and prognosis of this disease.

Objective:To analyze the factors affecting delayed chemotherapy in children with Burkitt lymphoma (BL) and their influence on prognosis.Methods:Retrospective cohort study. Clinical data of 591 children aged ≤18 years with BL from May 2017 to December 2022 in China Net Childhood Lymphoma (CNCL) was collected. The patients were treated according to the protocol CNCL-BL-2017. According to the clinical characteristics, therapeutic regimen was divided into group A, group B and group C .Based on whether the total chemotherapy time was delayed, patients were divided into two groups: the delayed chemotherapy group and the non-delayed chemotherapy group. Based on the total delayed time of chemotherapy, patients in group C were divided into non-delayed chemotherapy group, 1-7 days delayed group and more than 7 days delayed group. Relationships between delayed chemotherapy and gender, age, tumor lysis syndrome before chemotherapy, bone marrow involvement, disease group (B/C group), serum lactate dehydrogenase (LDH) > 4 times than normal, grade Ⅲ-Ⅳ myelosuppression after chemotherapy, minimal residual disease in the interim assessment, and severe infection (including severe pneumonia, sepsis, meningitis, chickenpox, etc.) were analyzed. Logistic analysis was used to identify the relevant factors. Kaplan-Meier method was used to analyze the patients' survival information. Log-Rank was used for comparison between groups.Results:Among 591 patients, 504 were males and 87 were females, the follow-up time was 34.8 (18.6,50.1) months. The 3-year overall survival (OS) rate was (92.5±1.1)%,and the 3-year event-free survival (EFS) rate was (90.5±1.2)%. Seventy-three (12.4%) patients were in delayed chemotherapy group and 518 (87.6%) patients were in non-delayed chemotherapy group. The reasons for chemotherapy delay included 72 cases (98.6%) of severe infection, 65 cases (89.0%) of bone marrow suppression, 35 cases (47.9%) of organ dysfunction, 22 cases (30.1%) of tumor lysis syndrome,etc. There were 7 cases of chemotherapy delay in group B, which were seen in COPADM (vincristine+cyclophosphamide+prednisone+daunorubicin+methotrexate+intrathecal injection,4 cases) and CYM (methotrexate+cytarabine+intrathecal injection,3 cases) stages. There were 66 cases of chemotherapy delay in group C, which were common in COPADM (28 cases) and CYVE 1 (low dose cytarabine+high dose cytarabine+etoposide+methotrexate, 12 cases) stages. Multinomial Logistic regression analysis showed that the age over 10 years old ( OR=0.54,95% CI 0.30-0.93), tumor lysis syndrome before chemotherapy ( OR=0.48,95% CI 0.27-0.84) and grade Ⅲ-Ⅳ myelosuppression after chemotherapy ( OR=0.55,95% CI 0.33-0.91)were independent risk factors for chemotherapy delay.The 3-year OS rate and the 3-year EFS rate of children with Burkitt lymphoma in the delayed chemotherapy group were lower than those in the non-delayed chemotherapy group ((79.4±4.9)% vs. (94.2±1.1)%, (80.2±4.8)% vs. (92.0±1.2)%,both P<0.05). The 3-year OS rate of the group C with chemotherapy delay >7 days (42 cases) was lower than that of the group with chemotherapy delay of 1-7 days (22 cases) and the non-delay group (399 cases) ((76.7±6.9)% vs. (81.8±8.2)% vs. (92.7±1.3)%, P=0.002).The 3-year OS rate of the chemotherapy delay group (9 cases) in the COP (vincristine+cyclophosphamide+prednisone) phase was lower than that of the non-chemotherapy delay group (454 cases) ((66.7±15.7)% vs. (91.3±1.4)%, P=0.005). Similarly, the 3-year OS rate of the chemotherapy delay group (11 cases) in the COPADM1 phase was lower than that of the non-chemotherapy delay group (452 cases) ((63.6±14.5)% vs. (91.5±1.3)%, P=0.001). Conclusions:The delayed chemotherapy was related to the age over 10 years old, tumor lysis syndrome before chemotherapy and grade Ⅲ-Ⅳ myelosuppression after chemotherapy in pediatric BL. There is a significant relationship between delayed chemotherapy and prognosis of BL in children.

Objective To compile nursing guidelines for diabetic patients undergoing ultrasound-guided islet transplantation through percutaneous portal vein puncture and catheterisation,providing valuable insights for the care of such patients during the surgical procedure.Methods Between December 2017 to September 2023,a total of 27 patients underwent 44 surgical procedures for ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterisation at our hospital.Nursing assistance was provided preoperatively,intraoperatively and postoperatively for all the procedures.Results All 27 patients who had undergone 44 surgical procedures successfully went through the ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterisation.Among the 44 surgical procedures,3(6.8%)resulted in upper abdominal and liver area pain,nausea and vomiting during surgery,8(18.2%)had transient increase of portal vein pressure during transplantation,and 6(13.6%)encountered active bleeding following the removal of the portal vein catheters.None of the patients developed delayed portal vein bleeding or complication such as portal vein thrombosis after the surgery.Conclusions Nursing interventions play a crucial role in ensuring the successful outcomes of ultrasound-guided islet transplantation.Following measures are the keys and they play an important roles in ensuring the smooth completion of ultrasound-guided islet transplantation:preoperatively,carefully assess the condition of recipients and provide them with psychological supports and patient education.Intraoperatively,closely monitor the vital signs,portal vein pressure and blood glucose as well as to prevent complications.Postoperatively,implement the nursing measures to prevent the recipients from postoperative bleeding of portal vein.

Objective To construct the triple pre-rehabilitation program for the patients undergoing pancreaticoduodenectomy to provide a theoretical basis for the preoperative management of this operation mode.Methods The raft plan was formed by the literature research and group discussion,then the experts were invited to conduct the two rounds of expert consultation,and the final draft of the plan was finally formed.Results The draft plan included the 3 first-level items,9 second-level items and 28 third-level items.The questionnaire recovery rate of the two rounds of expert correspondence was 100%,and the authority coef-ficients were 0.88 and 0.93,respectively.The mean importance and feasibility scores of each item in the two rounds of expert consultation were ≥3.5,and the coefficient of variation was<0.25.The first draft of the final formation plan included the 3 first-level items,9 second-level items and 31 third-level items.Conclusion This program has ne-cessity,scientificity and feasibility.Clarifying the specific contents and scope of preoperative management of this operation mode could provide a theoretical basis for medical staff to carry out pre-rehabilitation.

Background Adverse drug reactions (ADRs) to sodium dimercaptosulphonate (DMPS) mercury removal treatment have been reported in occupational mercury poisoning. In recent years, the number of cases of mercury poisoning due to mercury-containing cosmetics has been increasing, and ADRs to the use of DMPS are common in clinical practice. Objective To investigate the occurrence of ADRs and the influencing factors in patients with chronic mercury poisoning and mercury exposure treated with DMPS for mercury removal. Methods Patients treated with DMPS due to mercury poisoning at the Occupational Disease Department of Nanjing Prevention and Treatment Center for Occupational Diseases from June 2017 to December 2023 were included in the study. Information on demographics, baseline characteristics, and treatment regimens was collected at admission. Information on secondhand smoke, place of residence, and blood groups not collected at admission was collected in follow-up. The patients were divided into two groups according to whether ADRs occurred after the use of DMPS and were compared for clinical characteristics, and the influencing factors related to the occurrence of ADRs after DMPS treatment were analyzed by binary logistic regression. Results A total of 72 patients were enrolled in the study, of which 26 reported ADRs during mercury removal. A total of 29 ADRs occurred, mainly rash in 11 cases (37.9%), fever in 5 cases (17.2%), and nausea in 4 cases (13.8%). Most ADRs occurred in the second course (7 cases, 26.9%) and the third course (9 cases, 34.6%). Of the 22 non-menopausal women who experienced ADRs, 13 (59.1%) used DMPS in the week prior to menstruation. The logistic regression analysis showed that smoking (OR=27.911, 95%CI: 2.835, 725.809) and blood type O (OR=6.885, 95%CI: 2.014, 26.896) were associated with elevated occurrence of ADRs after DMPS treatment. Conclusions The probability of ADRs after DMPS treatment is not low, but mild presentations are predominant and resolved with immediate treatment, with a favourable prognosis. The O blood group, smoking individuals, and female patients using DMPS one week before menstruation may be more prone to ADRs.