Objective To investigate the risk factors associated with prolonged hospitalization in patients diagnosed with diabetic foot ulcers(DFU),to develop a predictive model,and to conduct internal validation of the model.Methods The clinical data of DFU patients admitted to West China Hospital,Sichuan University between January 2012 and December 2022 were retrospectively collected.The subjects were randomly assigned to a training cohort and a validation cohort at a ratio of 7 to 3.Hospital stays longer than 75th percentile were defined as prolonged length-of-stay.A thorough analysis of the risk factors was conducted using the training cohort,which enabled the development of an accurate risk prediction model.To ensure robustness,the model was internally validated using the validation cohort.Results A total of 967 inpatients with DFU were included,among whom 245 patients were identified as having an extended length-of-stay.The training cohort consisted of 622 patients,while the validation cohort comprised 291 patients.Multivariate logistic regression analysis revealed that smoking history(odds ratio[OR]=1.67,95%confidence interval[CI],1.13 to 2.48,P=0.010),Wagner grade 3 or higher(OR=7.13,95%CI,3.68 to 13.83,P＜0.001),midfoot ulcers(OR=1.99,95%CI,1.07 to 3.72,P=0.030),posterior foot ulcers(OR=3.68,95%CI,1.83 to 7.41,P＜0.001),multisite ulcers(OR=2.91,95%CI,1.80 to 4.69,P＜0.001),wound size≥3 cm2(OR=2.00,95%CI,1.28-3.11,P=0.002),and white blood cell count(OR=1.11,95%CI,1.05 to 1.18,P＜0.001)were associated with an increased risk of prolonged length of stay.Additionally,a nomogram was constructed based on the identified risk factors.The areas under the receiver operating characteristic(ROC)curves for both the training cohort and the validation cohort were 0.782(95%CI,0.745 to 0.820)and 0.756(95%CI,0.694 to 0.818),respectively,indicating robust predictive performance.Furthermore,the calibration plot demonstrated optimal concordance between the predicted probabilities and the observed outcomes in both the training and the validation cohorts.Conclusion Smoking history,Wagner grade≥3,midfoot ulcers,posterior foot ulcers,multisite ulcers,ulcer area≥3 cm2,and elevated white blood cell count are identified as independent predictors of prolonged hospitalization.Therefore,it is imperative that clinicians conduct a comprehensive patient evaluation and implement appropriate diagnostic and therapeutic strategies to effectively shorten the length of stay for DFU patients.

Objective To explore the characteristics of baseline inflammatory markers in diabetic foot patients and their relationship with the prognosis of diabetic foot ulcers.Methods The clinical data of diabetic foot patients(n=495)admitted to West China Hospital,Sichuan University since 2016 were retrospectively collected through the hospital electronic medical record system to analyze the characteristics of inflammatory markers and their relationship with the prognosis of diabetic foot ulcers.Results White blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)levels were significantly higher in patients defined as grade 4 on the Wagner Scale than those in patients defined as grade 0-3 on the Wagner Scale.Neutrophil percentage(NE％)was higher in Wagner grade-4 patients than those in Wagner grade-0 and grade-1 patients and higher in Wagner grade-3 patients than those in Wagner grade-0 patients.NE％,CRP,PCT,and IL-6 levels were positively correlated with the severity of diabetic foot,with the respective odds ratio(OR)at 95％confidence interval(CI)being 1.038(1.019-1.056),1.019(1.012-1.026),8.225(2.015-33.576),and 1.017(1.008-1.025).Using Wagner grade-0 patients as the reference,patients with higher WBC were more likely to progress to Wagner grade 2,3,and 4,with the respective OR(95％CI)values being 1.260(1.096-1.447),1.188(1.041-1.356),and 1.301(1.137-1.490);patients with higher ESR were more likely to progress to Wagner grade 3 and 4,with the respective OR(95％CI)values being 1.030(1.006-1.054)and 1.045(1.019-1.071).Baseline ESR(P=0.008),CRP(P=0.039),and IL-6(P=0.033)levels were lower in patients who had received antibiotics prior to their admission than those in patients who had not received antibiotics before admission.The levels of WBC,NE％,ESR,PCT,and IL-6 were lower in the full recovery group than those in the group of patients who did not respond to treatment.The higher the levels of NE％and IL-6,the worse the prognosis of diabetic foot ulcers became,with the respective OR(95％CI)values being 1.030(1.010-1.051)and 1.008(1.002-1.013).Conclusion The severity of diabetic foot ulcers increased with the rise in baseline levels of inflammatory markers.Elevated baseline NE％and IL-6 levels suggest a poor prognosis.Our findings suggest that early assessment of diabetic foot infection and standardized antibiotic therapy should be implemented to improve the prognosis.

Objective:To explore the effect of nursing based on Roy adaptation model on negative emotions and adverse reactions in patients with multiple myeloma during chemotherapy.Methods:Using the convenient sampling method, a total of 100 patients with multiple myeloma who were admitted to Zhoushan Hospital in Zhejiang Province from July 2017 to August 2019 were selected. They were divided into the control group and the observation group by lottery method, with 50 cases in each group. The control group was given routine nursing measures while the observation group was given nursing based on Roy adaptation model on basis of the control group. And patients in both groups were also given the same chemotherapy intervention.The incidence of negative emotions, chemotherapy compliance, nursing satisfaction and adverse reactions after nursing were compared between the two groups.Results:There were no statistically significant differences in the scores of anxiety and depression before nursing between the two groups ( P>0.05) . The scores of anxiety and depression of the two groups after nursing were lower than those before nursing, and the scores of the observation group after nursing were lower than those of the control group, and the differences were statistically significant ( P<0.01) . The incidence of adverse reactions after nursing in the observation group (12.00%, 6/50) was lower than that of the control group (48.00%, 24/50) , and the difference was statistically significant ( P<0.01) . In the observation group, the proportions of patients with good treatment compliance and nursing satisfaction were respectively 90.00% (45/50) and 96.00% (48/50) , which were higher than 64.00% (32/50) and 80.00% (40/50) in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Nursing based on Roy adaptation model on the basis of routine nursing can improve the adverse reactions of patients with multiple myeloma during chemotherapy, relieve their negative emotions and improve their compliance and nursing satisfaction, which is worthy of promotion and application.

Objective: To understand the status and genotype of norovirus in Wuhu, and provide the basic molecular epidemiological data for norovirus infection control and prevention, 2017. Methods: Anal swab and vomit specimens were collected during outbreaks from patients, primarily using fluorescence quantitative PCR to preliminarily identify the genotype of norovirus; according to preliminary result , through their respective specific primer, RT-PCR was applied, and sequencing was done to identify virus genotypes. Sequence alignment and phylogenetic analysis of norovirus was performed by using biological software. Results: Seventeen norovirus epidemics were observed in Wuhu area, a total of 137 specimens were collected. Real-time fluorescent quantitative PCR result showed that 77 specimens were norovirus nucleic acid testing positive, and all were GⅡ genotype. Through specific primers amplification, sequencing analysis showed that the 2017 outbreaks in Wuhu were caused only by two genotypes, GⅡ.3 and GⅡ. 2, including one case of GⅡ. 3, Six cases of GⅡ.2, and 10 epidemic aggregations, 8 cases of GⅡ. 2, and there were two cases of G Ⅱ. 4 Sydney 2012. Conclusions Norovirus GⅡ.2 genotype was dominant in norovirus outbreaks and the aggregation epidemics, other genotypes were occasionally seen in Wuhu, 2017.