Objective:To analyze the early warning value of laboratory examination on admission of patients with hemorrhagic fever with renal syndrome to critically ill patients.Meetods:In this study, a retrospective case-control study was used to analyze the clinical data and laboratory examination results of patients with hemorrhagic fever with renal syndrome admitted to the emergency department of Tangdu Hospital of Air Force Medical University from January 2021 to January 2022. According to the patient's laboratory indexes and clinical symptoms, the patients were divided into mild, moderate, severe and critical groups. The general data of the two groups were compared, and the independent risk factors of critically ill patients were screened by multi-factor logistic regression analysis, the predictive model of severe HFRS patients was constructed, and the ROC curve was drawn. .Results:Of the 164 patients with HFRS, 50 were in the severe group and 114 in the mild group. The serum levels of WBC, AST, ALT, Cr, BUN, DD and PCT in the severe group were higher than those in the mild group, while the levels of PLT, ALB and PTA in the severe group were lower than those in the mild group. Multiple logistic regression analysis showed that WBC, PLT and PCT were independent influencing factors for the progression of critically ill patients. The predictive model of severe HFRS was established as follows: logit (P) = -0.321 + 0.040 WBC (×10 9/L) -0.045 PLT (×10 9/L) + 0.086 PCT(ng/mL). The early warning ef?cacy of WBC, PLT, And PCT for severe HFRS was further analyzed. The area under the ROC curve (area under curve, AUC) was 0.779, 0.842, 0.862, and the optimal threshold was 10.435×109/L, 41.5 ×109/Land 2.97 ng/mL, respectively. The AUC of joint detection is 0.900, the sensitivity is 88.0%, and the speci?city is 82.5%, which is better than that of a single laboratory. . Conclusions:HFRS laboratory indexes have certain clinical signi?cance for the identi?cation of critically ill patients, in which serum WBC, PLT and PCT indexes are the risk factors of severe HFRS, which provides a theoretical basis for clinical diagnosis, treatment and prognosis of severe HFRS patients.

Objective:To analyze the correlation between psychological resilience and stigma, self-efficacy and self-esteem in patients with constipation after lower limb fracture surgery, and to determine nursing counter measures.Methods:A total of 102 patients who underwent lower limb fracture surgery in Jingdezhen Hospital of Traditional Chinese Medicine from April 2020 to March 2023 were convenience sampling selected as the study objects by a cross-sectional survey. They were divided into constipation group and normal group according to whether postoperative constipation was complicated. Baseline data, Psychological Resilience Scale (CD-RISC), Social Impact Scale (SIS), General Self-efficacy Scale (GSES), and Pearson ′s method was used to analyze the correlation between CD-RISC score and SIS score, GSES score, and RSES score in patients with constipation. Results:Totally 102 survey subjects aged 18-75 (38.87 ± 6.83), including 57 males and 45 females. Postoperative constipation occurred in 37 patients, accounting for 36.27% (37/102). The average age, constipation secret history rate, postoperative analgesic use rate, CD-RIS, SIS, GSES and RSES scores of the constipation group were (50.74 ± 5.52) years, 72.97% (27/37), 62.16% (23/37), (42.11 ± 5.03) points, (59.78 ± 6.40) points, (22.74 ± 3.57) points, (20.15 ± 2.32) points, respectively. The normal group was (37.81 ± 7.45) years old, 40.00% (26/65), 41.54% (27/65), (78.43 ± 5.95) points, (36.10 ± 4.03) points, (28.26 ± 3.53) points, (27.05 ± 5.29) points, respectively. The difference between the two groups was statistically significant ( t values were 7.52-31.29, χ2 values were 10.27 and 4.01, all P<0.05). In the constipation group, CD-RISC score was negatively correlated with SIS score, and positively correlated with GSES score and RSES score ( r values were -0.869, 0.608, 0.582, all P<0.05). Conclusions:The incidence of constipation after lower limb fracture is high, and its psychological resilience is related to stigma, self-efficacy and self-esteem. Clinical nursing intervention is needed to improve the prognosis of patients.

Objective:To study the multi-locus sequence typing (MLST) gene characteristics of Brucella isolates in Guizhou Province. Methods:Brucella strains, which were isolated from 2017 to 2021 in Guizhou Province (preserved in the Bacterial and Viral Seed Bank of Guizhou Center for Disease Control and Prevention) were identified Brucella and species/types by BCSP31-PCR and AMOS-PCR methods, respectively. MLST method was used for genotyping, and Biometrics 8.0 software was used for cluster analysis of the typing results. Results:A total of 32 strains of Brucella were isolated in Guizhou Province and identified as Brucella melitensis ( B.melitensis) by BCSP31-PCR and AMOS-PCR methods. These strains were classified into 2 ST types (ST8 and ST39) by MLST method, with 28 strains of ST8 type(87.5%) and 4 strains of ST39 type (12.5%). The 28 strains of ST8 type were distributed in 7 cities (prefectures) of Guizhou Province, while the 4 strains of ST39 type were only found in Qianxinan Buyi and Miao Autonomous Prefecture. The cluster analysis results showed that ST8 and ST39 types strains were clustered in a group with the reference strain of B.melitensis, and there was only one nucleotide site difference between ST39 and ST8 types in the glk gene, indicating a close genetic relationship. Conclusions:B.melitensis is the main pathogen of the brucellosis epidemic in Guizhou Province in recent years. ST8 is the dominant MLST genotype in Guizhou Province.

Objective:To evaluate the value of bedside ultrasound in evaluating volume responsiveness of patients with septic shock.Methods:A total of 102 patients with septic shock admitted to ICU of the First Affiliated Hospital of Hebei North University from April 2018 to February 2021 were selected. Patients were divided into response group and non-response group according to the value of stroke volume increase (ΔSV) after volume loading test (VE), and the hemodynamic parameters before and after VE were compared between the two groups. Pearson correlation was used to analyze the relationship between ΔSV and hemodynamic indexes. Receiver operating characteristic (ROC) curve was drawn to analyze the sensitivity and specificity of each hemodynamic index in evaluating volumetric reactivity in patients with septic shock.Results:Of the 102 patients, 54 responded and 48 did not. Before VE, the distensibility index of inferior vena cava (ΔIVC 1), espiratory variability index of inferior vena cava (ΔIVC 2), respiratory variability of aortic peak velocity (ΔVpeak AO), brachial artery maximum velocity variability (ΔVpeak BA) and respiratory rate of peak flow velocity of femoral artery (ΔVpeak CFA) in response group were higher than those in non-response group (all P<0.05), but there was no statistical significance in heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) between 2 groups (all P>0.05). After VE, the HR, ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA in response group were significantly decreased, while MAP and CVP were significantly increased (all P<0.05). The CVP was significantly decreased in the non-response group ( P<0.05), while other indexes were not significantly changed. Before VE, the ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA were positively correlated with ΔSV ( r=0.589, 0.647, 0.697, 0.621, 0.766; all P<0.05). There was no correlation between CVP and ΔSV ( r=-0.345, P>0.05). Before VE, the area under the curve of ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA were all >0.7, indicating high sensitivity and specificity. Conclusions:Bedside ultrasound monitoring ΔIVC, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA can better evaluate the volume response of patients with septic shock, and can provide a reference basis for clinical fluid resuscitation treatment.

【Objective】 To establish a stable human megakaryocytic cell line with low expression of Le^y antigen to further study the role of Le^y on activation of platelets. 【Methods】 The expression level of the Le^y antigen in a human megakaryocytic cell line, DAMI, was determined using Western Blot and flow cytometry. The expression level of genes that encode fucosyltransferase (FUTs), which was involved in the biosynthesis of Le^y antigen, was also determined to identify the candidate genes to be knocked out. The candidate FUT gene was knocked out via a CRISPR/Cas 9 gene knockout system and cells with low Le^y antigen expression were sorted by flow cytometry. The sorted cell line was cultured and characterized. 【Results】 The Le^y was expressed intensively on DAMI cell. FUT1 and FUT4 mRNA was expressed relatively higher, both may be key enzymes for the biosynthesis of the Le^y antigen. In the DAMI cell line with the knockout of FUT1 gene, the expression of the Le^y adntigen was remarkedly reduced, while cell proliferation was not affected compared to the wildtype control cells. 【Conclusions】 Since various FUTs contributes to the biosynthesis of the Le^y antigen, the knockout of the primary one of them cannot totally block its biosynthesis, but only reduce its expression. In this study, a stable FUT gene knockout human megakaryocyticcell line is established using CRISPR/Cas 9 technology, which provides basis for the study of the impact of the Le^y antigen on platelet functions.

【Objective】 To investigate the frequencies of HLA-B alleles in Jiangsu Han population from Chinese Marrow Donor Program (CMDP) Jiangsu Branch in 8 prefecture-level cities, compare and analyze the distribution of common susceptible alleles at HLA-B locus in 8 prefecture-level cities. 【Methods】 The HLA-B locus of 27 249 unrelated volunteers from CMDP Jiangsu Branch were genotyped by polymerase chain reaction–sequence based typing (PCR-SBT) method, and frequencies of HLA-B alleles of 8 prefecture-level cities were calculated and compared. 【Results】 A total of 145 HLA-B alleles were detected in Jiangsu Han population, among them 104, 113, 83, 88, 88, 85, 84, 72 HLA-B alleles were detected in Changzhou, Nanjing, Zhenjiang, Yangzhou, Huai’an, Suqian, Xuzhou, and Yancheng Han population, respectively. In general, the common alleles in Changzhou, Yangzhou and Zhenjiang were very similar, and the most common alleles were B^*46∶01, 13∶02, 40∶01 and 58∶01. The common alleles in Nanjing, Huai’an and Suqian were rather similar, and the most common alleles were B^*13∶02, 46∶01, 40∶01, 58∶01 and 51∶01. The common alleles in Yancheng were rather similar to Nanjing, Huai’an and Suqian, with only difference in the order of B^*40∶01 and B^*58∶01. The common alleles in Xuzhou were close to Nanjing, Huai’an and Suqian too, with only difference in the order of B^*40∶01 and B^*46∶01. 【Conclusion】 The results reflected the distribution of HLA-B alleles of Jiangsu Han population from 8 prefecture-level cities and the gene distribution was basically consistent with the regional distribution. The major difference in HLA-B locus in Jiangsu 8 prefecture-level cities was B ^* 13∶02 and B ^* 46∶01. The frequency of B ^* 13∶02 in Northern Jiangsu (Huai’an, Suqian, Xuzhou, Yancheng) is much higher than that of B ^* 46∶01, and that in Nanjing is slightly higher than the frequency of B ^* 46∶01, which is consistent with that in North China. The frequency of B ^* 46∶01 in Southern Jiangsu (Changzhou), Yangzhou and Zhenjiang is higher than that of B ^* 13∶02, which is consistent with that in South China. The polymorphism analysis of alleles at HLA-B locus in 8 cities in Jiangsu Province provided significant basic data for the study of the correlation between HLA-B locus genes and diseases, as well as the population genetics and anthropology in Jiangsu Han population.

Objective: To detect the clinicopathological features, immunophenotype, diagnosis, and differential diagnosis of composite pheochromocytoma(CP). Methods: Five cases of CP were collected at Zhejiang Provincial People′s Hospital from January 2011 to January 2019. The clinical, radiological, histologic, immunohistochemical and outcome data were analyzed; the diagnosis and differential diagnosis were discussed. Results: The patients′ age range was 52-68 years (mean 59 years, median 54 years), There were 4 males and 1 female, and the male to female ratio was 4∶1. Tumor size was 3-4 cm (mean 3.6 cm, median 3.5 cm). The most common clinical manifestation was adrenal mass. Histologically, the classical feature was two distinct morphologic components, one with tumor cells arranged in irregular nests, and with fine granular and basophilic oramphophilic cytoplasm; the other was composed of scattered ganglion cells in the background of Schwann cells organized in interwoven bundles. The components of pheochromocytoma expressed PHOX2B(5/5), synaptophysin (5/5), CgA (5/5), the sustentacular cells expressed S-100 protein; the components of ganglioneuroma expressed S-100 protein (5/5), NF (5/5), the ganglion cells were weakly positive for PHOX2B, synaptophysin and CgA. All the cases were surgically resected and all patients were free of recurrence at follow-up. Conclusions CP is rare adrenal tumor, and it has typical histologic features but no specific clinical manifestations. Attention should be paid to its characteristic histomorphology with the use of PHOX2B, CgA, synaptophysin and S-100 protein immunohistochemistry that is helpful for its diagnosis.

Objective:To investigate the effect of background music therapy on the pain management of school age burn children during function exercises.Methods:A total of 78 burned children of school age were divided into intervention group (39 cases) and control group (39 cases) according to random number table method. The control group received routine function exercises, the intervention group was listening background music during function exercises. The pain degree was evaluated by Face, Legs, Activity, Crying, Consolability (FLACC) scores, children's medical fears was determined by Broome's Child Medical Fear Questionnaire (CMFQ), activities of daily living was assessed by Barthel index.Results:At 1th, 2th, 3th, 5th, 6th, 8th, 10th, the FLACC scores were (3.82±0.46), (3.25±0.49), (3.29±0.57), (3.04±0.59), (2.82±0.58), (2.90±0.48), (2.31±0.32) points in the intervention group, (4.26±0.54), (3.88±0.84), (4.09±0.86), (3.82±0.65), (3.75±0.68), (3.39±0.72), (2.97±0.64) points in the control group, the differences were statistically significant ( t values were 3.457-6.363, all P<0.05). After intervention, the fear medical environment, medical operation fear fear, self scores were (6.84±1.44), (5.28±1.41), (4.18±1.58) points in the intervention group, and (7.96±1.34), (7.56±2.43), (5.78±1.31) points in the control group, the differences were statistically significant ( t=3.511, 4.995, 4.779, all P<0.05). However, the scores of activity of daily life between two groups was no statistical difference ( P>0.05). Conclusions:Background music therapy can alleviate pain degree and medical fear of burn children during function exercises and serve as a useful non-drug strategy for pain management.

Objective To introduce the operation skills of tail vein injection in conscious rats , and improve the success rate of ingection .Methods The rat was fixed by the operator with a self-made binding clothes , one person assists to fix the rat tail, one person performs puncture , and one person performs injection .During the injection process , we should minimize the injury to the rat tail and the stress caused by operation , strictly limit the needle point , the number of puncture , the maximum dose and injection speed , and to make the needle position away from the injection site to avoid contamination and waste of the drug solution .Results The operation method was successfully established and it was fast , stable, with good repeatability and high degree of coordination .Conclusion This operation is rapid, reliable and stable, worthy of recommendation , especially for the intravenous injection of expensive drugs .