Objective To investigate the characteristic distribution of traditional Chinese medicine(TCM)syndrome types in gouty arthritis patients complicated with bone erosion,and to analyze the associated factors.Methods A total of 318 gouty arthritis patients hospitalized in the Rheumatology and Immunology Department of Foshan Hospital of Traditional Chinese Medicine between November 2021 and November 2023 were included.The patients were allocated to a bone erosion group(142 cases)and a non-bone erosion group(176 cases)according to the findings of musculoskeletal ultrasound.The clinical data of gender,age,body height,body mass,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),course of gout,findings of musculoskeletal ultrasound,complete blood count[white blood cell count(WBC),platelet count(PLT),hemoglobin(Hb),and red blood cell count(RBC)],blood uric acid(UA),creatinine(Cr),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)of the patients during hospitalization were collected.Differences in general information,laboratory parameters,and distribution of TCM syndrome types were compared between the two groups,and then the potential influencing factors of bone erosion in gouty arthritis patients were explored.Results(1)Analysis of general information showed that the bone erosion group had longer course of gout and slightly lower BMI than that the non-bone erosion group,and the differences were statistically significant(P＜0.05 or P＜0.01).However,there were no statistically significant differences in age,body height,body mass,SBP and DBP among the patients of the two groups(P>0.05).(2)Analysis of laboratory indicators showed that the levels of Cr,UA,ESR and TC in the bone erosion group were significantly higher than those in the non-bone erosion group,and the differences were statistically significant(P＜0.05 or P＜0.01).However,no statistically significant differences in the levels of CRP,WBC,RBC,PLT and LDL-C were presented between the two groups(P＞0.05).(3)Analysis of the distribution of TCM syndromes showed that in the bone erosion group,stagnant-heat obstruction syndrome accounted for the largest proportion(33.10%),followed by phlegm-turbidity obstruction syndrome(29.58%),damp-heat accumulation syndrome(22.54%),and liver-kidney yin deficiency syndrome(14.79%);in the non-bone erosion group,damp-heat accumulation syndrome accounted for the largest proportion(38.07%),followed by liver-kidney yin deficiency syndrome(32.95%),phlegm-turbidity obstruction(14.77%),and stagnant-heat obstruction(14.20%).There was statistically significant difference in the distribution of TCM syndromes between the two groups(P＜0.01).(4)The results of logistic regression analysis suggested that the higher the levels of ESR,UA,and TC,the longer the course of gout.And the TCM syndromes of stagnant-heat obstruction and phlegm-heat obstruction were the risk factors for bone erosion in gouty arthritis(P＜0.05 or P＜0.01).Conclusion Gouty arthritis patients with bone erosion exhibit higher UA,ESR,Cr,and TC levels,longer course of disease,and higher incidence of stagnant-heat obstruction syndrome and phlegm-turbidity obstruction syndrome.Bone erosion in gouty arthritis is closely associated with elevated UA,ESR,TC,and some specific TCM syndrome patterns.

Objective To explore the risk factors of aspiration during hospitalization in patients with ischemic stroke (IS) and establish a predictive model. Methods Based on the case-control design, clinical materials of 316 IS patients treated in the Department of Neurology of Suzhou Ninth Hospital Affiliated to Soochow University from March 2022 to October 2023 were retrospectively collected. According to incidence of aspiration during hospitalization, the patients were divided into case group with 89 cases (aspiration occurred during hospitalization) and control group with 227 cases (no aspiration occurred during hospitalization). Univariate and multivariate Logistic regression analyses were performed in both groups to screen out the risk factors of aspiration during hospitalization in IS patients. R software was used to extract 70 % of the data from the two groups as the training set (establishing a Nomogram model), and the remaining 30 % data was used as test set. Value of predictive model was evaluated by area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration curve, and decision curve. Results There were significant differences in the terms of age, the National Institutes of Health Stroke Scale (NIHSS) score, number of lesions, homocysteine (Hcy) level, spontaneous cough, and grading of Wada drinking water test between the case group and the control group (P < 0.05). Multivariate Logistic analysis showed that large age (OR=2.201, 95 %CI, 1.254 to 3.865), high NIHSS score (OR=4.816, 95 %CI, 1.652 to 14.041), multiple lesions (OR=2.649, 95 %CI, 1.249 to 5.613), high level of Hcy (OR=1.501, 95 %CI, 1.044 to 2.158), weakened or absent spontaneous cough (OR=3.384, 95 %CI, 1.639 to 6.987), and high grading of Wada drinking water test (OR=2.878, 95 %CI, 1.422 to 5.783) were the risk factors of aspiration during hospitalization in IS patients (P < 0.05). In the training set, the AUC of the Nomogram model for predicting aspiration during hospitalization in IS patients was 0.872 (95 %CI, 0.827 to 0.919), and was 0.859 (95 %CI, 0.807 to 0.904) in the test set. The calibration curve analysis showed that P value was 0.869 in the training set and 0.898 in the test set. The decision curve analysis for both the training set and test set showed that the Nomogram model was of good clinical applicability. Conclusion The risk of aspiration during hospitalization in IS patients is related to large age, high NIHSS score, multiple lesions, high level of Hcy, weakened or absent spontaneous cough, and high grading of Wada drinking water test. The Nomogram predictive model established on these factors can effectively evaluate the risk of aspiration during hospitalization in IS patients.

Objective:To investigate the application and effects of WeChat official account in improving the nursing trainees' core post competency.Methods:The study included in 105 nursing trainees of Batch 2015 as experimental group, taking the nursing practice WeChat official account based on the routine clinical teaching pattern, and 95 nursing trainees of Batch 2014 as control group, taking traditional teaching mode. At the end of the internship, the scores of special examinations for nursing students and the national examination for nursing qualifications ("nursing qualification examination" for short) of the two group were compared, and the critical thinking ability, ability to acquire information lifelong learning ability, nurse-patient clinical communication ability and teaching satisfaction of the two groups of students were analyzed. SPSS 23.0 software was used for t test. Results:The scores of special examinations, nursing qualification examination and each module at main dimensions of the core post competency of nursing students in the experimental group were higher than those in the control group ( P<0.05). The nursing trainees in the experimental group were satisfied with the teaching effects of the WeChat official account. Conclusion:The WeChat official account in clinical nursing practice helps improve the quality of clinical practice teaching and assist in enhancing core post competency of nursing trainees.

Objective:To investigate the changes of monocytic myeloid-derived suppressor cells (M-MDSC) in children with acute Kawasaki disease (KD) and its roles in the immunological pathogenesis of KD.Methods:A total of 38 children with acute KD were enrolled in the present study and 32 age-matched healthy children were selected as control group. The proportions of HLA-DR -CD11b + CD33 + CD15 -CD14 + M-MDSC and CD4 + CD25 + CD127 - regulatory T cells (Treg) in peripheral blood, concentrations of reactive oxygen species (ROS) and expression of arginase-1 (Arg-1), CD39, CD73, CD40, CD40L and CCR5 at protein levels were detected by flow cytometry. Quantitative real-time PCR was used to evaluate the transcription levels of inducible nitric oxide synthase (iNOS) in M-MDSC and the transcription levels of cytotoxic T-lymphocyte associated antigen 4 (CTLA4) and lymphocyte-activation gene 3 (LAG3) in Treg. Concentrations of NO, CCL3, CCL4, CCL5, IL-10 and TGF-β in the supernatants of cell culture were measured by ELISA. Results:(1) The proportion of HLA-DR -CD11b + CD33 + CD15 -CD14 + M-MDSC, the concentration of intracellular ROS and the expression of iNOS, CD39 and CD73 in M-MDSC decreased significantly in patients with acute KD as compared with those in the control group ( P<0.05), and the concentrations of NO, IL-10 and TGF-β in culture supernatant of M-MDSC were lower than those in the control group upon lipopolysaccharide (LPS) stimulation for 48 h ( P<0.05). All of the aforementioned indexes restored to some extent after intravenous immunoglobulin (IVIG) therapy ( P<0.05). No statistical differences were found in Arg-1 expression between healthy controls and patients with KD before or after IVIG therapy ( P<0.05). (2) CD40 expression on M-MDSC was significantly lower in the acute KD group than in the control group ( P<0.05). The concentrations of CCL3, CCL4 and CCL5 in the culture supernatants of M-MDSC were lower in the acute KD group than in the control group after LPS stimulation ( P<0.05). With IVIG treatment, all of the indexes were up-regulated significantly ( P<0.05), although CD40 expression was still lower in the acute KD group than in the control group ( P<0.05). (3) The proportion of CD4 + CD25 + CD127 -Treg and the expression of CTLA4, LAG3, CD40L and CCR5 reduced significantly in patients with acute KD as compared those in healthy controls ( P<0.05), and all increased remarkably after IVIG therapy ( P<0.05). Pearson correlation analysis showed a positive correlation between the proportions of M-MDSC and Treg in patients with acute KD ( r=0.58, P<0.05). Conclusions:Insufficiency and impaired function of M-MDSC might be a major cause of immune dysfunction in patients with acute KD.

Objective To investigate the relationship between the channel design of tandem-andovoid (T&O) applicator and the doses to organs at risk (OARs) and target volume in three-dimensional brachytherapy for advanced cervical carcinoma.Methods The data on 15 patients with advanced cervical carcinoma treated with three-dimensional brachytherapy in our hospital from 2015 to 2016 were collected,and 30 randomly selected high-dose-rate titanium T&O plans were retrospectively studied.CT-guided,conformal brachytherapy plans were generated.To simulate T&O applicator,the tandem applicator was virtually compared with the T&O plans with the target volume and OARs remaining unchanged.The DVH parameters of the rectum,bladder,and sigmoid were compared using the paired t test.Results For T&O plans and tandem applicator plans,the mean D2cc of the rectum was 387.8±96.8 cGy and 340.8±88.1 cGy,respectively;the mean D2cc of the bladder was 443.2± 87.5 cGy and 719.4± 243.0 cGy,respectively;the mean D2cc of the sigmoid was 330.3±88.8 cGy and 383.1±105.6 cGy,respectively.In the T&O plans,the doses to the rectum,bladder,and sigmoid were within the limits (rectum:D2cc ≤ 500 cGy;bladder:D2cc ≤ 550 cGy;sigmoid:D2c ≤ 500 cGy),while D2cc of the bladder and sigmoid was higher or partially higher than the limits.T&O plans showed a significant reduction in bladder D2cc and sigmoid D2cc compared with the tandem applicator plans (all P＜0.05).Conclusions Compared with tandem applicator plans,plans using T&O applicator provide significant sparing of bladder and sigmoid tissues in three-dimensional brachytherapy for cervical carcinoma,but the toxicities require further investigation.

Objective To explore the effect of tumor necrosis factor-alpha(TNF-α) blockade therapy on circulating Th17 cell percentage and serum interleukin (IL)-17 level in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods Twenty-seven RA and 22 AS patients were recruited, of which 14 cases from both diseases received 40 weeks TNF blockade therapy. Twenty-four healthy blood donors were used as controls. The frequencies of circulating Th17 cells were determined by flowcytometry, and serum IL-17 level were measured by enzyme linked immunosorbent assay(ELISA). Results Significantly higher baseline circulating Th17 cells were observed in active RA and AS patients compared with the healthy controls[RA 1.03%(0.66%,1.78%) vs controls 0.50%(0.43%,0.67%), Z=-3.236, P<0.01; AS(1.16±0.09)%vs controls (0.59 ±0.061)% , t =5.226, P <0.01]. Similarly, serum IL-17 level were significantly elevated in patients with both diseases compared with controls[RA(32.3±2.5) pg/ml vs controls(14.3±2.5) pg/ml, t=5.070, P<0.01; AS 28.98(23.84,36.14) pg/ml vs controls 11.84(5.33,22.12) pg/ml, Z=-4.103, P<0.01]. After TNF-α blockade therapy, serum IL-17 was significantly decreased in both diseases groups[RA △(-13.5± 5.0) pg/ml and AS △(-16.0±1.9) pg/ml]. In contrast, no significant differences were found in the frequencies of circulating Th17 cells[RA △(0.104 5±0.212 6)% and AS △(0.002 5±0.183 8)%]. Conclusion Th17 cells and IL-17 have been implicated in the pathogenesis of RA and AS. TNF-α blockade can partially inhibit the function of Th17 cells. However, it is unable to reduce the frequencies of these cells in the circulation after 40 weeks therapy, which may explain the reasons for the relapse.

Objective To investigate the relationship between dose-volume histogram (DVH) parameters and the late side effects (LSE) of the rectum in external-beam radiotherapy combined with computed tomography (CT)-based brachytherapy for locally advanced cervical cancer.Methods From 2008 to 2011,18 patients with stage ⅡB-ⅢB cervical cancer received external-beam radiotherapy and CTbased brachytherapy.The DVH parameters of high-risk clinical target volume (HR CTV) D90,point A dose,and D1 cm3 and D2 cm3 of the rectum and bladder were calculated by Oncentra HDR treatment planning system.Survival outcomes were followed up and rectal LSE were evaluated by RTOG/EORTC grades.Results The point A dose and HR CTV D90 were (93.0 ± 5.5) Gy and (73.6 ± 11.9) Gy,respectively.The median follow-up was 26 months.No recurrence was found during follow-up.Eight patients had mild and moderate rectal LSE,and their rectum D2 cm3 and D1 cm3 were significantly higher than those of patients without mild and moderate rectal LSE (D2 cm3:(87.4 ± 3.8) Gy vs.(75.8 ± 7.4) Gy,P =0.004 ; D1 cm3:(96.4±6.6) Gy vs.(80.5± 7.1) Gy,P=0.001).Conclusions HR CTV D90 in CT-based brachytherapy for locally advanced cervical cancer might be lower than that in the MRI-based plan.Rectum D2 cm3 is recommended to be less than 75 Gy.

ObjectiveTo identify the early predictors of refractory epilepsy (RE). MethodsAll 173 epileptic patients with correct diagnosis and reasonable treatment were enrolled. The 106 patients were classified as drug non-responsive epilepsy (DNR-EP). The remaining 63 patients were classified as drugresponsive epilepsy (DR-EP). With multiple logistic regression, the clinical characteristics between the two groups were compared to identify the early predictors of RE. ResultsMultiple logistic regression analysis demonstrated that more than 10 seizures before treatment (OR =4. 46, 95％ CI 1.60-12. 40, P =0. 004),mental retardation at early time ( OR =19. 87, 95％ CI 3. 60-109. 78, P =0. 001 ) and abnormal electroencephalogram(EEG) with epileptiform wave after treatment ( OR =7.57, 95％ CI 2. 54-22. 56,P ＜0. 01 ) were independent predictors of RE.Response to initial therapy was a protective factor of RE (OR=0.05, 95％ CI 0.018-0. 139, P＜0.01). ConclusionPatients who have many seizures before treatment, mental retardation at the early time, epileptiform abnormality in EEG after treatment and who are resistant to initial therapy are likely to develop into refractory epilepsy.

Objective To evaluate target-volume coverage and organ at risk (OAR) protection achieved with conventional radiotherapy (CRT), three dimensional eonformal radiotherapy (3DCRT) , and intensity-modulated radiotherapy(IMRT) through dosimetric comparison in patients with cervical cancer after hysterectomy. Methods The planning CT scans of 10 patients treated with pelvic radiation after hysterectomy for cervical cancer were used to generate CRT,3DCRT and IMRT plans for this study. Clinical target volume(CTV) was contoured on the individual axial CT slices of every patient. The CTV was then uniformly expanded by 1.0 cm to create the planning target volume (PTV). The small bowel, rectum, bladder, bone marrow, ovaries, and femoral heads were outlined for the organ at risk (OAR) evaluation. The CRT ,3DCRT and IMRT plans were generated using commercial planning software. CRT plan was prescribed to deliver 45 Gy to the reference point,while IMRT and 3DCRT plans were 45 Gy to 95% of the FFV. Isodose line and dose volume histograms(DVH) were used to evaluate the dose distribution in CTV and OAR. Results For 10 patients, the average volume of CTV receiving the prescribed dose of CRT was significantly lower than 3DCRT( Q = 8.27,P ＜ 0.01 ) and IMRT( Q = 8.37, P ＜ 0.01 ), respectively. Comparing with the CRT plan,the 3DCRT and IMRT plans notably reduced the volume of bowel at 30 and 45 Gy levels. The IMRT plan significantly spared rectum and bladder at 30 and 45 Gy levels comparing with the CRT ( P ＜ 0.01 ) and 3DCRT( P ＜ 0.05 ) plans,while the 3DCRT plan significantly spared rectum and bladder at 45 Gy level comparing with the CRT( P ＜0.01 ) plans. For 4 patients with ovarian transposition, the average doses of ovary over 3 Gy were 2 patients with the 3DCRT and IMRT plans, and 2 with all three plans. Conclusions IMRT and 3DCRT are superior to CRT in improving dose coverage of target volume and sparing of OAR ,while IMRT being the best. The superiority of IMRT and 3DCRT is obvious in sparing bone marrow at high dose levels. IMRT,3DCRT and CRT could not spare the transposed ovary effectively.

Objective To solve the problem of the skin resource and skin quality after excision of skin scar and other lesions to a certain extent. Methods Using the skin external expander that was designed and developed by the authors, we expanded skin at the given time and quantity. Results 28 patients had received the treatment, and they all had a large proportion of skin-scard. Obviously their skin-scar was eliminated throughly after using the skin external expander and commissure being hooked in. These 28 cases have shown that there would be no chance for the patients to suffer from hyperplastic akin-scard after their first stage of treatment. Conclusion The skin external expander is really a new method to solve the problem of the skin resource and skin quality after exscinding skin scar and other lesions to a certain extent.