ObjectiveTo compare the incidence of postoperative shivering between female patients undergoing gynecological and general surgery and to examine perioperative factors associated with postoperative shivering. MethodsThis retrospective study included 12 186 patients who underwent gynecological or general surgery between January 1， 2022， and March 15， 2024， of whom 10 884 female patients constituted the primary analysis population. Among the female patients， 1：1 nearest-neighbor propensity score matching was performed using a caliper of 0.02 on the raw propensity score scale， with exact matching on American Society of Anesthesiologists （ASA） physical status. After matching， the incidence of postoperative shivering was compared using the McNemar test. Conditional logistic regression stratified by matched pair was used to assess the associations of surgical categories and perioperative factors with postoperative shivering. ResultsBefore propensity score matching， the incidences of postoperative shivering were 2.98% （28/940） in the general surgery group and 4.94% （491/9 944） in the gynecological surgery group （P=0.007）. After matching， 881 matched pairs were obtained， and the absolute standardized mean differences （SMDs） for all covariates were < 0.10. The incidences of postoperative shivering were 3.06% （27/881） in the general surgery group and 4.99% （44/881） in the gynecological surgery group. The McNemar test without continuity correction yielded P=0.044， whereas the exact McNemar test showed a P value of 0.057. Unifactorial conditional logistic regression showed that gynecological surgery was associated with higher odds of postoperative shivering than general surgery ［odds ratio （OR）=1.63， 95% confidence interval （CI）： 1.01-2.63， P=0.046］. However， the association was not statistically significant in the multifactorial conditional logistic regression ［adjusted odds ratio （aOR）=1.62， 95%CI： 0.78-3.37， P=0.197］. Each 30-min increase in the duration of surgery was associated with 32% higher odds of postoperative shivering （aOR=1.32， 95%CI： 1.07-1.62， P=0.009）. Each 1 °C increase in the minimum intraoperative body temperature was associated with lower odds of postoperative shivering， although the association did not reach statistical significance （aOR=0.32， 95%CI： 0.10-1.02， P=0.053）. ConclusionAfter propensity score matching， the incidence of postoperative shivering was higher among female patients undergoing gynecological surgery than among those undergoing general surgery； however， neither the exact comparison nor the adjusted association reached statistical significance. A longer duration of surgery was associated with higher odds of postoperative shivering， whereas a higher minimum intraoperative body temperature may be associated with lower odds.

ObjectiveTo compare the incidence of postoperative shivering between female patients undergoing gynecological and general surgery and to examine perioperative factors associated with postoperative shivering. MethodsThis retrospective study included 12 186 patients who underwent gynecological or general surgery between January 1， 2022， and March 15， 2024， of whom 10 884 female patients constituted the primary analysis population. Among the female patients， 1：1 nearest-neighbor propensity score matching was performed using a caliper of 0.02 on the raw propensity score scale， with exact matching on American Society of Anesthesiologists （ASA） physical status. After matching， the incidence of postoperative shivering was compared using the McNemar test. Conditional logistic regression stratified by matched pair was used to assess the associations of surgical categories and perioperative factors with postoperative shivering. ResultsBefore propensity score matching， the incidences of postoperative shivering were 2.98% （28/940） in the general surgery group and 4.94% （491/9 944） in the gynecological surgery group （P=0.007）. After matching， 881 matched pairs were obtained， and the absolute standardized mean differences （SMDs） for all covariates were < 0.10. The incidences of postoperative shivering were 3.06% （27/881） in the general surgery group and 4.99% （44/881） in the gynecological surgery group. The McNemar test without continuity correction yielded P=0.044， whereas the exact McNemar test showed a P value of 0.057. Unifactorial conditional logistic regression showed that gynecological surgery was associated with higher odds of postoperative shivering than general surgery ［odds ratio （OR）=1.63， 95% confidence interval （CI）： 1.01-2.63， P=0.046］. However， the association was not statistically significant in the multifactorial conditional logistic regression ［adjusted odds ratio （aOR）=1.62， 95%CI： 0.78-3.37， P=0.197］. Each 30-min increase in the duration of surgery was associated with 32% higher odds of postoperative shivering （aOR=1.32， 95%CI： 1.07-1.62， P=0.009）. Each 1 °C increase in the minimum intraoperative body temperature was associated with lower odds of postoperative shivering， although the association did not reach statistical significance （aOR=0.32， 95%CI： 0.10-1.02， P=0.053）. ConclusionAfter propensity score matching， the incidence of postoperative shivering was higher among female patients undergoing gynecological surgery than among those undergoing general surgery； however， neither the exact comparison nor the adjusted association reached statistical significance. A longer duration of surgery was associated with higher odds of postoperative shivering， whereas a higher minimum intraoperative body temperature may be associated with lower odds.

Polycystic ovary syndrome(PCOS)is a complex disease that significantly impacts women's reproductive and metabolic health.The reprogramming of glucose metabolism points to fundamental changes in energy metabolism,which are central to the imbalance in energy metabolism,hormonal abnormalities,increasing insulin resistance,and chronic inflammatory states observed in PCOS.This represents a core pathological link in the pathogenesis of PCOS.The theory of"Spleen Qi to Dispersing Essence"provides a comprehensive overview of spleen function,essential for ensuring the normal operation of organs and the distribution of Qi,blood,and bodily fluids.It serves as a crucial theoretical support for the treatment of PCOS with traditional Chinese medicine.This article explores the role of regulating PCOS based on the theory of"Spleen Qi to Dispersing Essence"with a focus on the reprogramming of glucose metabolism.The mechanism of traditional Chinese medicinal treatments that assist Spleen Qi to Dispersing Essence is closely related to regulating glucose metabolism reprogramming,offering a novel research direction for the treatment of PCOS with TCM.

Polycystic ovary syndrome(PCOS)is a complex disease that significantly impacts women's reproductive and metabolic health.The reprogramming of glucose metabolism points to fundamental changes in energy metabolism,which are central to the imbalance in energy metabolism,hormonal abnormalities,increasing insulin resistance,and chronic inflammatory states observed in PCOS.This represents a core pathological link in the pathogenesis of PCOS.The theory of"Spleen Qi to Dispersing Essence"provides a comprehensive overview of spleen function,essential for ensuring the normal operation of organs and the distribution of Qi,blood,and bodily fluids.It serves as a crucial theoretical support for the treatment of PCOS with traditional Chinese medicine.This article explores the role of regulating PCOS based on the theory of"Spleen Qi to Dispersing Essence"with a focus on the reprogramming of glucose metabolism.The mechanism of traditional Chinese medicinal treatments that assist Spleen Qi to Dispersing Essence is closely related to regulating glucose metabolism reprogramming,offering a novel research direction for the treatment of PCOS with TCM.

OBJECTIVE To investigate the effect of polymorphisms of solute carrier organic anion transporter family, member 1B3(SLCO1B3) gene on the pharmacodynamics of mycophenolate mofetil(MMF) in patients with lupus nephritis. METHODS Patients with lupus nephritis who were treated in Jieyang People’s Hospital from September 2019 to April 2021 were selected. All subjects were treated with MMF for at least 12 months, or discontinued due to poor efficacy. The efficacy of MMF was evaluated. The SLCO1B3 334T>G/699G>A(rs4149117/rs7311358) genotype was detected using Agena MassARRAY®, and the correlation between gene polymorphisms and MMF pharmacodynamics was analyzed using SPSS 25.0 software. RESULTS The genotype frequencies of SLCO1B3 334T>G/699G>A were in Hardy-Weinberg equilibrium. The probability of poor MMF treatment effect of 334GG/699AA carriers was significantly higher than that of 334TT/699AA and 334TG/699GA carriers(P<0.001); Logistic regression showed that both 334GG/699AA and urine protein>2.5 g·(24 h)−1 were the risk factors for poor MMF treatment[OR=4.038(1.731, 9.420), P<0.001; OR=4.157(1.705, 10.137), P=0.002]. Combined analysis showed that patients with both 334GG/699AA genotype and urine protein>2.5 g·(24 h)−1 were at higher risk for poor efficacy[OR=8.563(3.301, 22.216), P<0.001]. CONCLUSION SLCO1B3 334T>G/699G>A is related to the efficacy of MMF treating lupus nephritis, and 334GG/699AA carriers are more likely to result in poor efficacy.

Humans ; Asthma/drug therapy* ; Biological Therapy

Objective: To improve the clinical understanding of Castleman disease (CD) with different types of thoracic involvement, including their clinical features, radiological and pathological findings, diagnosis and current treatment strategies. Methods: Retrospective analysis of 30 patients diagnosed with CD with thoracic involvement and hospitalized between June 2009 and May 2019 in The First Affiliated Hospital of Guangzhou Medical University was performed. Patients were divided into three groups for subsequent analysis based on the clinical data: CD with bronchiolitis obliterans (BO) , unicentric Castleman disease (UCD) without BO, and multicentric Castleman disease (MCD) without BO. Results: Among the 30 patients, there were 5 (16.7%) patients diagnosed with BO, 18 (60.0%) patients had UCD without BO and 7 (23.3%) patients had MCD without BO. The average age of MCD without BO patients was significantly older than that of BO and UCD without BO patients[ (49.29±5.39) ys vs (27.20±3.76) ys and (37.17±2.87) ys; P=0.005 and 0.034, respectively) ]. Pulmonary symptoms were commonly seen in BO group (100%) and MCD without BO group (71.4%) . while no pulmonary symptoms were seen in UCD without BO group. Key abnormal laboratory findings were erythrocyte sedimentation rate (ESR) increase (40%in BO group and 57.1% in MCD without BO group) and hypoxia (60% in BO group and 28.6% in MCD without BO group) . Other abnormal laboratory findings seen in MCD without BO group included anemia and IgG increase (both 57.1%) . Notably, all patients in BO group had extremely severe mixed ventilation dysfunction in the lung function test. CT scan showed lung parenchyma involvement in BO group (100%) , in UCD without BO group (11.1%) featured by solitary pulmonary nodule and in MCD without BO group (57.1%) featured by diffuse lesions in bilateral lungs. The size of lymph nodes was significantly smaller in MCD without BO group comparing to that in BO group and UCD without BO group[short diameter (1.83±0.51) cm vs (4.73±1.63) cm and (3.62±0.26) cm; P=0.006 and 0.011, respectively]. All patients (100%) in the BO group had a pathological type of transparent vascular variant while the same pathological type accounts for 88.9% in UCD without BO patients. The predominantly pathological type (57.1%) was plasma cell variant in the MCD without BO group. Oral ulcers presented in all patients in BO group but were relieved after the mass resection and immunomodulatory therapy, but the pulmonary symptoms were still progressively aggravated. Thoracoscopic mass excision was the main treatment for UCD without BO patients while chemotherapy, immunomodulatory and targeted therapy were commonly used for MCD without BO treatment. Conclusion The age, clinical symptom, laboratory finding, lung function, imaging manifestation, pathology, treatment and prognosis were different among the three groups. This classification could improve clinical understanding of the disease.

Objective: To analyze the infection composition and drug resistance to Gram-negative (G^-) bacilli in children′s respiratory tract in Suzhou, in order to provide evidence for rational use of antibiotics clinically. Methods: G^- bacilli culture samples were collected from 21 561 cases of nasopharyngeal secretions from patients with respiratory tract infection admitted at the Department of Respiratory, Children′s Hospital of Soochow University from January 2007 to December 2016, including 21 246 cases in general wards, and 315 patients who were transferred to the respiratory department after treatment in the Intensive Care Unit(ICU), and the children were divided into the general ward group and the ICU group, and the pathogens were compared and the changes in bacterial susceptibility were dynamically observed between the 2 groups. Results: The primary G^-bacteria for respiratory infection was Haemophilus influenzae, followed by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii.The detection rates of Klebsiella pneumoniae and Pseudomonas aeruginosa in the ICU group were 16.8% (21/125 strains)and 14.4%(18/125 strains), respectively, which were significantly higher than those in the general ward group [10.0%(208/2 071 strains), 9.2%(190/2 071 strains)]. The detection rates of G^-bacteria in the ICU group were 33.7%(106/315 cases), which were significantly higher than those in the general ward group [9.4%(1 997/21 246 cases)], and the difference was statistically significant(χ²=210.325, P<0.001). The rare G^-bacillus such as Stenotrophomonas maltophilia, Acinetobacter junii and Burkholderia onion were higher in the ICU group [17.6%(22/125 strains)] than that in the general ward group [6.4% (132/2 071 strains)]. The rate that of G^-bacteria with two or more mixed infection in ICU group [17.0% (18/106 cases)] was significantly higher than in the general ward group [3.4%(68/1 997 cases)], and the difference was statistically significant(χ²=47.3, P<0.05). For the mixed infection, the ICU group was mainly composed of Klebsiella pneumoniae mixed with Pseudomonas aeruginosa or Escherichia coli, while the general ward group was composed of Haemophilus influenzae mixed with Pseudomonas aeruginosa or Escherichia coli.The sensitivity of Haemophilus influenzae to Ampicillin, Sultamicillin, Cefuroxime, Cefaclor and Azithromycin decreased, and the sensitivity to Chloramphenicol, Tetracycline and Trimethoprim+ Sulfamethoxazole increased year by year, and there were statistically significant differences in different years (all P<0.05). The sensiti-vity to Escherichia coli to Ceftazidime decreased year by year, and the sensitivity to Ampicillin and Levofloxacin increased year by year, and there were statistically significant differences in different years (all P<0.05). The sensitivity to Klebsiella pneumoniae to Cefoperazone/Sulbactam and imipenem decreased, and the sensitivity to Ciprofloxacin and Levofloxacin increased, and there were statistically significant differences in different years (all P<0.05). The sensitivity to Pseudomonas aeruginosa, Cefoperazone/Sulbactam and Ceftriaxone decreased year by year, and the sensitivity to Levofloxacin increased, and there were statistically significant differences in different years (all P<0.05). The detection rate of carbapenem-resistant strains of Klebsiella pneumoniae and Pseudomonas aeruginosa showed an increasing trend, and there were statistically significant differences in different years (all P<0.05). Conclusions The primary G^-bacteria for respiratory infections is Haemophilus influenzae, G^-bacilli especially, the mixed infection of G^-bacilli, is more likely to cause severe and critical respiratory infections.The resistance rate of G^-bacteria infection in children′s respiratory tract to commonly used antibiotics is generally on the rise.

Objective To analyze the clinical characteristics and laboratory indexes of pneumonia complicated with pertussis syndrome in Suzhou area in order to provide the basis for rational treatment.Methods Children who had been hospitalized at Department of Respiratory,Children's Hospital of Soochow University during January 2012 to October 2016 were enrotled and diagnosed as pneumonia complicated with pertussis syndrome.A total of 236 cases were enrolled.Multiple pathogen detection and clinical information were collected in all patients.The subjects were divided into 28 days-＜ 3 months group,3-＜ 6 months old group,6-＜ 12 months old group and ≥ 12 months old group.The clinical data of children in each age group were retrospectively analyzed.Results Pneumonia complicated with pertussis syndrome was easy to occur within 6 months of infants,with the highest incidence in the 3-＜ 6 months group,there was a significant difference among the different age groups (x2 =231.870,P ＜ 0.05) [28 d-＜ 3 months group:5.3％ (102/1 910 cases),3-＜6 months group:5.7％ (76/1 341 cases),6-＜ 12 months group:2.0％ (36/1 762 cases),≥12 months group:0.4％ (22/5 304 cases)].The patients could become sick all the year round,with the highest incidence in summer[2.6％ (72/2 740 cases)in spring,3.7％ (96/2 611 cases)in summer,2.1％ (56/2 749 cases) in autumn,and 0.48％ (12/2 487 cases)in winter],and there were significant differences among the different seasons (x2 =62.380,P ＜0.001).Clinical symptoms were paroxysmal spasmodic cough,33.0％ (78/236 cases) of the performance with wheezing,mainly in the older than 3 months group.The incidence of fever was positively correlated with age(x2 =12.938,P ＜ 0.05).Peripheral white blood cell count and lymphocyte percentage increased,and the 3-＜ 6 months old group increased markedly.White blood cell count as high as (19.01 ± 11.99) × 109/L,the highest percentage of lymphocytes was up to 0.80,platelets were significantly increased in more than 80％ of children.The incidence of C-reactive protein (CRP) was negatively correlated with age,28 days-＜ 3 months group more prone to have high CRP.Pulmonary inflammatory pathology showed multiple pulmonary involvement by chest radiography,and it was more likely to occur in 28 d-＜ 3 months group.Viruses,bacteria and mycoplasma pneumoniae (MP) could cause pneumonia associated with pertussis syndrome,and mixed infection occurred in 56 cases.The top three pathogens were rhinovirus,MP and Streptococcus pneumoniae,and mixed infection was more prone to occur in 28 d-＜ 3 months group.Conclusion Pneumonia complicated with pertussis syndrome is easy to occur within 6 months of infants,with the highest incidence in summer.Viruses,bacteria and MP all could cause pneumonia associated with pertussis syndrome,and mixed infection could occur in some cases.The top three pathogens are rhinovirus,MP and Streptococcus pneumoniae.

Objective To explore the status and influencing factors of cultural competence in the junior college student nurses in Shanghai in order to provide a reference basis to improve their cultural competence. Methods Purposive sampling method was used in the survey, and 412 students participated were selected form one Shanghai junior college. It included 167 students majored in general nursing, and 89 students majored in nursing ( oral hygiene) , and 84 students majored in midwife, 72 students majored in Sino-American nursing. We applied the culture competence assessment ( CCA) scale to evaluate the cultural competence, awareness and behavior of the nursing students. Results The score of cultural competence of the students was (4. 19 ± 0. 78). The scores of cultural awareness and sensitivity was (5. 04 ± 0. 94). The score of cultural behavior was (3. 51 ± 0. 25). Conclusions The student nurses culture competence is medium, and cultural awareness and sensitivity is higher, but they are lack of cultural behavior. So it is essential to improve their cultural competence.