Objective To explore the clinical effect of nursing under nutritional risk assessment(NUNRA)in patients with mandibular tumors undergoing fibula musculocutaneous flap grafting.Methods A total of 120 patients with mandibular tumor who underwent fibula musculocutaneous flap grafting in the Department of Otolaryngology of the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2022 were selected as research objects.They were numbered in the order of 1-120 and divided into control group and intervention group according to odd and even numbers,with 60 cases in each group.The control group received routine rehabilitation nursing.The intervention group were given NUNRA.The mandibular joint function,nutritional index and complications were compared between the two groups before intervention and 14 d after intervention.Results There was no significant difference in the mandibular joint function or nutrition index between the two groups before intervention(P>0.05).After 14 d of intervention,the scores of mandibular movement,joint pressing diagnosis and muscle pressing diagnosis of the intervention group were higher than those of the control group(P<0.05);the nutritional indexes,such as transferrin(TRF),albumin(ALB),total protein(TP)and prealbumin(PAB)in the intervention group were superior to those in the control group(P<0.05);and the incidences of gastrointestinal disorders,infection,wound swelling and malnutrition in the intervention group were lower than those in the control group(P<0.05).Conclusion NUNRA can improve mandibular function and nutrition index and reduce the incidences of postoperative complications in patients with mandibular tumors undergoing fibula musculocutaneous flap grafting.

Objective:To explore the relationship between thyroid parenchymal echogenicity abnormalities and thyroid function evolution in health examination population.Methods:It was a cohort study. According to the inclusion and exclusion criteria, participants were selected from individuals who underwent thyroid color ultrasound and thyroid function tests at the Health Management Center of Tianjin Medical University General Hospital from January to December 2017. Data including age, gender, smoking history, alcohol consumption history, personal medical history, and thyroid function re-examination information were collected. Follow-up was conducted until the occurrence of thyroid function abnormalities or until the end of the follow-up period. The cumulative incidence rate and incidence density of thyroid function abnormalities were evaluated. Cox regression analysis was used to analyze the relationship between thyroid parenchymal echogenicity abnormalities and thyroid function evolution.Results:A total of 6 754 participants were included in this study, with an average age of (45.80±12.12) years, and females accounted for 42.7%. The mean follow-up time was 1.82 years, with a cumulative follow-up duration of 12 263 person-years. During the follow-up period, 154 new cases of thyroid function abnormalities occurred, with a cumulative incidence rate of 2.28% (95% CI: 1.94%-2.66%) and an incidence density of 12.56/1 000 person-years (95% CI: 10.66/1 000-14.69/1 000 person-years). The multivariate adjusted Cox regression analysis showed that individuals with thyroid parenchymal echogenicity abnormalities had a significantly increased risk of developing isolated thyroid stimulating hormone abnormalities and thyroid function abnormalities, with HR(95% CI) of 3.09 (2.02-4.73) and 2.92(1.96-4.33), respectively, both P<0.001. Stratified analysis showed that, except for body mass index <18.5 kg/m 2, current smoking, and current alcohol consumption, all other stratified factors showed a significant increase in the risk of thyroid function abnormalities in individuals with thyroid parenchymal echogenicity abnormalities. Conclusion:Thyroid parenchymal echogenicity abnormalities are important risk factors for the evolution of thyroid function abnormalities. Continuous monitoring of thyroid function should be given due attention.

This article explores the shortcomings and proposes research directions from the overview of mobile medicine and its application in the prevention, self-management, and health education of female stress urinary incontinence, with a view to providing new ideas and methods for the prevention and treatment of female stress urinary incontinence.

Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus (HIV) patients in whom antiretroviral therapy (ART) was unsuccessful.Methods:In this retrospective study,a total of 9,418 HIV patients who failed in ART during 2004-2016 were included and divided into two treatment groups-Group 1 (treatment time ≤ 3 years,n1 =5,218) and Group 2 (treatment time ＞ 3 years,n2 =4,200).Patient follow-up data,including age,cluster of differentiation 4 (CD4) count,and viral load,glucose,creatinine,and triglyceride levels,were extracted from electronic health record databases.Covariance analysis for repeated measures was used to analyze the biochemical indicators,and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.Results:The median initial CD4 count was 175.0 cells/μl (interquartile range,77.0-282.0),while the initial CD4 counts for Group 1 were lower than those for Group 2 (P ＜ 0.05).A significant interaction between group and time effects was observed (P ＜ 0.05) in total cholesterol (TC).Changes in hemoglobin level among HIV patients were also significantly associated with treatment time (P =0.001).The initial CD4 count (odds ratio [OR] =0.756),female sex (OR =0.713),Zerit (d4T) (OR =1.443),TC (OR =1.285),and aspartate aminotransferase level (OR =1.002) were significantly associated with the survival time of dead patients with HIV (P ＜ 0.05).Additionally,the initial CD4 count (OR =1.456),age (OR =1.022),time interval (OR =0.903),patient's living status (OR =0.597),d4T (OR =2.256),and triglyceride (OR =0.930) and hemoglobin levels (OR =0.997) were significantly associated with the treatment time of HIV patients with drug withdrawal (P ＜ 0.05).Conclusion:The initial biochemical parameters can affect the survival and treatment time of HIV patients.With a comprehensive understanding of the physiological and biochemical indicators of patients,we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.

Through the effort in nearly 40 years of Tanzania, the total number of reported cases, the prevalence of HIV/AIDS and the number of death have declined, while the number of patients receiving antiretroviral therapy has increased significantly in Tanzania. At the same time, however, there are new challenges that require more attention, such as the HIV spread to rural areas, middle and lower social classes, and female teenagers. Although the overall performance of the HIV/AIDS prevention and control response is great, there is still a need to survey the new trends of this disease at the micro-level in Tanzania. In addition, there is a necessity of interdisciplinary concern due to the prevalence of heterosexual anal sex in Tanzania.

Background: The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy (HAART). However, the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern. The aim of this study was to determine factors influencing antiretroviral regimen changes among people living with HIV/AIDS in China. Methods: This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART, and gathered relevant information from infectious disease hospitals. The following information were collected: social-demographic characteristics, antiretroviral therapies, CD4 cell counts, virus loads, reasons for changing medication and other related data. Mean and percentages were used to describe the frequency of regimen change among patients, and binary logistic regression was employed to test the factors influencing regimen change. Results: 1,123 people who had experienced regimen change were included in the analysis. On average, patients remained on HAART for 10.2 months before changing regimen, and the average CD4 cell count and viral load (VL) were 383.1 cells/μl and 28,132.4 copies/mL respectively when changing regimen. The reasons for modification were determined as treatment failure (52.5％), adverse reactions (32.3％), and other reasons including pregnancy (15.2％). There are significant differences in regimen change among people with different genders (P<0.001), modes of transmission (P<0.001), duration of HAART (P<0.001) and initial CD4 cell counts (P=0.0024). Males, drug users, people taking long-term medication, and those with lower initial CD4 counts when starting HAART tend to change regimen. Conclusion: Treatment failure was the main reason for the change of HAART regimen. Males, drug users, people on long-term medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.

Objective To explore nursing effect of liver cancer patients without placing peritoneal drainage tube in postoperation.Methods A total of 1200 liver cancer cases were randomly divided into no placing peritoneal drainage tube group and placing peritoneal drainage tube group.Similarities and differences of nursing were compared.Postoperative exhaust time,defecation time,hospitalization and incision healing,postoperative complications including intraperitoneal bleeding,abdominal distention,intraabdorninal infection and incision infection were observed.Results Compared with control group,postoperative exhaust and defecation time were earlier,hospitalization and incision healing time were significantly shorter in observation group (P ＜ 0.05).Rate of intraperitoneal bleeding in both groups showed no significant difference (P ＞ 0.05).Rate of abdominal distention,intraabdominal infection and incision infection were respectively 3.1％,2.7％ and 2.3％ in observation group,which was significantly lower compared with control group (P ＜ 0.05).Conclusion Postoperative liver cancer without placing peritoneal drainage tube can promote rehabilitation and relieves the pain of patients.

Objective To explore nursing effect of liver cancer patients without placing peritoneal drainage tube in postoperation.Methods A total of 1200 liver cancer cases were randomly divided into no placing peritoneal drainage tube group and placing peritoneal drainage tube group.Similarities and differences of nursing were compared.Postoperative exhaust time,defecation time,hospitalization and incision healing,postoperative complications including intraperitoneal bleeding,abdominal distention,intraabdorninal infection and incision infection were observed.Results Compared with control group,postoperative exhaust and defecation time were earlier,hospitalization and incision healing time were significantly shorter in observation group (P ＜ 0.05).Rate of intraperitoneal bleeding in both groups showed no significant difference (P ＞ 0.05).Rate of abdominal distention,intraabdominal infection and incision infection were respectively 3.1％,2.7％ and 2.3％ in observation group,which was significantly lower compared with control group (P ＜ 0.05).Conclusion Postoperative liver cancer without placing peritoneal drainage tube can promote rehabilitation and relieves the pain of patients.

Aim To investigate the treatment effect of Tongxinluo(TXL)combined peripheral blood derived mesenchymal stem cells(PB-MSCs)transplantation on angiogenesis of HIF-1 /VEGF pathway and miR-21 0 in diabetic foot(DF)rats.Methods Seventy male Spra-gue-Dawley rats were fed with high-fat diet and given
combined streptozotocin injection to build diabetic rat model.The femoral artery and vein of right lower ex-tremity of modeled rats were ligatured to induce DF model.The normal rats in the same batch copied is-chemia model served as control group.The modeled rats were divided into 6 groups :model group ,TXL
group,Cilostazol group,PB-MSCs group,TXL com-bined PB-MSCs(T-MSCs)group and Cilostazol com-bined PB-MSCs(C-MSCs)group.After the treatment for 28 days,animal gastrocnemius muscle and serum were taken for detection,in which serum was used to detect VEGF-A and HIF-1 α by ELISA,and muscle was used to detect VEGF-A and VEGF-R2 by Western blot,and VEGF-A by RT-PCR.Results Compared with the control group,the expressions of VEGF-A, HIF-1 α,VEGF-R2 and miR-21 0 in the model group were significantly reduced(P <0.01 ).Compared with the model group,the expressions of VEGF-A,VEGF-
R2 and miR-21 0 in each treatment group were signifi-cantly increased(P <0.01 ),where the expressions of VEGF-A,HIF-1 α,VEGF-R2 and miR-21 0 in the T-MSCs were higher than these in the TXL,cilostazol and PB-MSCs group(P <0.05,P <0.01 ).Conclusion TXL combined with PB-MSCs transplantation may be regulated by HIF-1 /VEGF pathway and miR-21 0,pro-moting endothelial cell proliferation,differentiation, and promoting the formation of new blood vessels.

Objective To investigate the effect of 5-azacytidine(5-AZA) on apoptosis of bone marrow mesenchymal stem cells(BMSCs).Methods BMSCs were isolated from bone marrow of mouse tibia and femur; the expression of MSC specific markers CD44 and CD90 in BMSCs was measured by immunofluorescence staining;BMSCs were cultured in vitro in the medium supplemented with 0,10 and 20 μmol/L 5-AZA for 48 hours.Cell apoptosis was measured with fluorescent labeled inhibitor of caspases (FLICA) apoptosis kit and 4',6-diamidino-2-phenylindole (DAPI) staining ;the expression of apoptosis-related proteins Annexin V and Caspase-3 in the treated BMSCs was detected by Western blot.Results In this study,BMSCs positively expressed MSC specific markers CD44 and CD90.DAPI staining and Caspase-3 staining both showed that 10 and 20 μmol/L 5-AZA markedly increased apoptotic rate of BMSCs;the apoptosis-positive rate in DAPI staining was (21.086 ± 2.601) ％,(34.467 ± 3.724) ％ and (46.512 ± 3.864) ％,the apoptosis-positive rate in Caspase-3 staining was (5.354 ± 0.735)％,(15.462 ± 2.385)％ and (28.190 ± 4.190)％ in the controls,10 and 20 μmol/L 5-AZA groups,and there were significant differences among the control group and 5-AZA treated groups(all P ＜0.01).Western blot assay showed that Annexin V and Caspase-3 were both markedly upregulated in 5-AZA treated cells;the relative level of Annexin V expression was(26.612 ±2.184)％,(42.873 ±4.313)％ and (50.056 ± 4.457) ％,the relative level of Caspase-3 expression was (19.231 ± 2.683) ％,(38.618 ± 5.385) ％ and(91.235 ± 7.116)％ in the controls,10 and 20 μmol/L 5-AZA groups,and there were significant differences among the control group and 5-AZA treated groups (all P ＜ 0.01).Conclusion The commonly used doses of 5-AZA can induce apoptosis of BMSCs.