Objective:To evaluate the effect of Qishi Tongguan Prescription on pregnancy outcomes after interventional recanalisation in patients with tubal infertility (TFI).Methods:This was a retrospective study based on real-world and propensity score matching. Totally 260 patients with TFI from January 2020 to October 2021 in Shuguang Hospital of Shanghai University of Traditional Chinese Medicine and Maternal and Child Health Hospital of Pudong New Area were selected as observation subjects, and were divided into 123 cases in the TCM combination group and 137 cases in the control group based on whether they were treated with Qishi Tongguan Prescription in combination with interventional revascularization. Propensity score matching (PSM) was used as a covariate to obtain a new sample of inter group covariate equilibrium, and confounding factors that may affect the pregnancy outcome of TFI patients undergoing interventional recanalization surgery were used as covariates. The intrauterine pregnancy rate, ectopic pregnancy rate, biochemical pregnancy rate, early abortion rate and adverse reactions of the two groups of patients within 12 months of follow-up were compared, and the influence of TFI intervention and recanalization combined with Qishi Tongguan Prescription on intrauterine pregnancy rate was evaluated.Results:Age, years of infertility, type of infertility, history of miscarriage, history of ectopic pregnancy, history of biochemical pregnancy, history of uterine surgery, history of pelvic laparotomy, and degree of tubal patency had an effect on whether intrauterine pregnancy was achieved after interventional reversal in patients with TFI ( P<0.05), with age [ OR (95% CI) was 0.843 (0.769, 0.926)], history of pelvic laparotomy [ OR (95% CI) was 0.477 (0.248, 0.920)] and the degree of tubal obstruction [ OR (95% CI) was 0.152 (0.046, 0.500)] were independent factors ( P<0.01 or P<0.05). 81 patients were seen in each of the 2 groups after PSM, of whom the intrauterine pregnancy rates in the combined herbal group at 9 and 12 months after recanalisation were 48.1% (39/81) and 58.0% (47/81) respectively, compared with 32.1% (26/81) and 35.8% (29/81) in the control group, with statistical significance between the 2 groups ( χ2 values of 4.34 and 8.03, respectively, P<0.01); there was no statistical significance in the ectopic pregnancy rate, biochemical pregnancy rate and early abortion rate between the 2 groups ( P>0.05). There were no significant adverse reactions during the treatment. Conclusion:Qishi Tongguan Prescription combined with interventional recanalization can effectively improve the intrauterine pregnancy rate and shorten the waiting time for pregnancy in patients with TFI with higher safety.

Objective:To analyze the distribution and drug resistance of the pathogen of bloodstream infections in patients with malignancies in Shanxi Province Cancer Hospital.Methods:A retrospective case series study was conducted. A total of 8 654 patients with malignancies whose blood culture was detected in Shanxi Province Cancer Hospital between January 2019 and December 2021 were collected, and venous blood was drawn for blood culture. WHONET 5.6 software and SPSS 23.0 software were used to analyze the distribution and drug resistance of the pathogen of bloodstream infections.Results:A total of 600 (6.9%) pathogens were isolated, including 413 (68.8%) strains of Gram-negative bacteria, 168 (28.0%) strains of Gram-positive bacteria, 19 (3.2%) strains of fungi. The top 5 gram-negative bacteria were Escherichia coli (37.7%), Klebsiella pneumoniae (14.2%), Enterobacter cloacae (4.5%), Pseudomonas aeruginosa (3.0%), and Acinetobacter baumannii (2.5%). The top 5 gram-positive bacteria were Staphylococcus aureus (4.2%), Enterococcus faecium (4.0%), Staphylococcus hominis (3.8%), Staphylococcus epidermidis (3.5%) and Streptococcus (3.0%); except Klebsiella pneumoniae, there were no statistically significant differences in the composition ratio of other major pathogens from 2019 to 2021 (all P > 0.05). The resistance rates of Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae to ampicillin were 94.7% (214/226), 100.0% (85/85) and 96.3% (26/27); the resistance rates of those to ciprofloxacin were 61.9% (140/226), 17.6% (15/85) and 7.4% (2/27); and the resistance rates of those to cefoperazone were 62.4% (141/226), 30.6% (26/85) and 25.9% (7/27), respectively. The resistance rates of P. aeruginosa and Acinetobacter baumannii to carbapenems were 5.5% (1/18) and 93.3% (14/15). Staphylococcus aureus, Staphylococcus hominis, Staphylococcus epidermidis were predominantly Staphylococcus. Enterococcus faecium and Enterococcus faecalis were the main types of enterococcus. Positive blood culture samples were mainly distributed in hematology department and intensive care unit. Non-Hodgkin lymphoma (39 strains) and acute myeloid leukemia (12 strains) were the main diseases. Conclusions:The main pathogen of bloodstream infection in patients with malignancies in this area is Gram-negative bacteria, and drug resistance is common. Hospitals should rationally use antibiotics by combining with drug sensitivity test.

Objective To explore the factors influencing the pregnancy rate after fallopian tube recanalization(FTR),and to construct and validate a nomogram prediction model.Methods The clinical data of a total of 322 female patients with tubal obstructive infertility,who received FTR at the Wuhan Municipal Third Hospital of China between January 2018 and December 2022,were retrospectively analyzed.According to whether the female patient had natural pregnancy or not within 12 months after FTR treatment,the female patients were divided into the pregnant group and the non-pregnant group.Logistic regression analysis was used to determine the independent factors influencing pregnancy.The female patients were randomly divided into training group and validation group at 1∶1 ratio.A nomogram model was constructed in the training group,and the predictive efficacy of the model was verified in the validation group by using receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DCA).Results The natural pregnancy rate at one year after FTR was 45.34％(146/322).Age＞35 years,primary infertility,duration of infertility＞3 years,distal fallopian tube obstruction,and moderate to severe tubal lesion were the independent risk factors affecting the pregnancy rate after FTR(all P＜0.05).The constructed nomogram model had a good differentiation and calibration ability and it carried a high degree of clinical utility.Conclusion The nomogram model constructed in this study can effectively predict the risk of infertility within one year after FTR treatment,which is helpful for formulating the individualized therapeutic scheme for infertility female patients.

Objective To observe the effects of probiotics and lactulose synergistic action on gastroin-testinal motility,mucosal function and disease progression in elderly patients with type 2 diabetes mellitus(T2DM)nephropathy constipation.Methods A total of 108 elderly patients with T2DM nephropathy consti-pation admitted and treated in this hospital from May 2021 to March 2023 were selected as the study subjects and divided into the observation group,control group 1 and control group 2 by the random number table meth-od,36 cases in each group.The control group 1 was treated with bifidobacterium tetrad tablet,the control group 2 adopted the lactulose treatment,and the observation group was treated with bifidobacterium tetrad tablet combined with lactulose.The clinical efficacy,constipation symptoms before treatment and in 1,4 weeks after treatment,gastrointestinal motility,serum cerebrointestinal peptide[substance P(SP),nitric oxide(NO),vasoactive intestinal peptide(VIP)],intestinal mucosal barrier function[D-lactic acid(DLC),diamine oxidase(DAO),lipopolysaccharide(LPS)],renal function[creatinine(Cr),urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)]and Toll-like receptor 4(TLR4)/nuclear factor κB(NF-κB)mRNA ex-pression were compared between the groups.Results After 1-,4-week treatment,the total effective rate,bari-um discharge rate at different time points in the observation group were higher than those in the control group 1 and control group 2,and the scores of rectal,abdominal and fecal traits in the observation group were lower than those in the control group 1 and control group 2(P＜0.05),but there was no statistically significant difference between the control group 1 and control group 2(P＞0.05).The serum NO and VIP levels in the observation group were lower than those in the control group 1 and control group 2(P＜0.05),the SP level was higher than that in the control group 1 and control group 2(P＜0.05).After 4-week treatment,the levels of serum DLC,DAO and LPS in the observation group were lower than those in the control group 1 and con-trol group 2(P＜0.05);the Cr and BUN levels,TLR mRNA expression and NF-κB mRNA expression in the observation group and control group 1 were decreased compared with before treatment(P＜0.05),the eGFR level was increased compared with before treatment(P＜0.05),but the above indexes had no statistically sig-nificant difference between these two groups(P＞0.05).Conclusion Probiotics and lactulose in the treat-ment of elderly patients with T2DM nephropathy constipation could play a synergistic role,alleviate the con-stipation symptom,promote the gastrointestinal motility and restore the intestinal mucosal barrier function,which may be reach the anti-inflammation and anti-apoptosis goal by inhibiting TLR4/NF-κB,so as to inhibit the further development of diabetic nephropathy.

Objective To analyze the relationship between serum a proliferation inducing ligand(APRIL)and galactin-1(Gal-1)levels with clinical features and prognosis in patients with epithelial ovarian cancer(EOC).Methods EOC patients(n=132)who admitted in Handan Hangang Hospital of Hebei Province from January 2018 to June 2020 were selected as the cancer group,and were grouped into a survival group(n=56)and a death group(n=76)based on their three-year survival after discharge.Meanwhile,healthy in-dividuals(n=68)who underwent physical examination were regarded as the healthy group.Enzyme linked immunosorbent assay was applied to detect serum APRIL and Gal-1 levels in all subjects.Clinical data of all patients were collected and their relationship with serum APRIL,Gal-1 levels and prognosis was analyzed.Ka-plan-Meier method was applied to analyze the relationship between serum APRIL and Gal-1 levels and the prognosis of EOC patients.Cox regression was applied to analyze the relevant factors affecting the prognostic death of EOC patients.The prognostic value of serum APRIL in patients with EOC was analyzed by receiver operating characteristic(ROC)curve.Results The serum APRIL and Gal-1 expression levels in the cancer group were greatly higher than those in the healthy group,and the differences were statistically significant(P＜0.05).The serum APRIL and Gal-1 levels in the death group were greatly higher than those in the sur-vival group,and the differences were statistically significant(P＜0.05).Clinical data analysis showed that se-rum APRIL and Gal-1 levels were not related to the age of EOC patients(P＞0.05),but were related to tumor location,tumor diameter,The International Febderation of Gynecology and Obstetrics(FIGO)staging,differentiation degree,lymph node metastasis,histological classification,and levels of cancer antigen 125(CA125)and human epididymis protein 4(HE4),and FIGO staging,differentiation degree,lymph node me-tastasis,histological classification,and levels of CA125 and HE4 also significantly affected the prognosis of pa-tients(P＜0.05).FIGO stage Ⅲ+Ⅳ,low differentiation,lymph node metastasis,serous tissue classification,CA125≥200 U/mL,HE4≥200 pmol/L,and high expression of APRIL and Gal-1 were all risk factors for prognostic death in EOC patients(P＜0.05).The three-year survival rate of APRIL high expression patients(25.37％)was greatly lower than that of APRIL low expression patients(60.00％),and the three-year sur-vival rate of Gal-1 high expression patients(27.94％)was greatly lower than that of Gal-1 low expression pa-tients(57.81％),,and the differences were statistically significant(P＜0.05).ROC curve showed that the ar-ea under the curve(AUC)of the combination of APRIL and Gal-1 for predicting the prognosis was 0.925,which was significantly higher than that of the diagnosis of the two alone,(Zcombined-APRIL=4.061,P＜0.001,Zcombined-Gal-1=3.424,P＜0.001),with a sensitivity and specificity of 86.84％and 83.93％,respectively.Conclu-sion The expression levels of serum APRIL and Gal-1 are greatly elevated in EOC patients,and their levels are related to tumor location,tumor diameter,FIGO staging,lymph node metastasis,histological classifica-tion,CA1 25,HE4,and differentiation degree.The expression levels of both have great application value in the prognosis evaluation of EOC patients.

Objective:To construct a hierarchical management model of performance objectives,and to explore its application value in the management of medical equipment procurement process.Methods:The procurement performance evaluation indicators were screened from the medical equipment procurement declaration level,process level,use level and disposal level,and the comprehensive evaluation model was developed by entropy weight method and data envelopment analysis(DEA)method to form the process management plan at the level of personnel,system,data and equipment.A total of 717 sets of medical equipment purchased by Beijing Youan Hospital from 2019 to 2022 were selected,and the conventional management mode(348 units)and hierarchical management mode(369 units)were used for management according to different performance objectives evaluation methods.The performance objectives achievement,the quality of procurement process management and the satisfaction of clinical allocation management of medical equipment procurement under different management modes were compared.Results:The 369 units of equipment under the hierarchical management model included operating room equipment,laboratory equipment,inpatient treatment equipment,disinfection supply equipment and other medical equipment,and the performance objectives achievement of the procurement were(96.10±3.46)%,(96.76±2.65)%,(95.59±2.52)%,(96.06±2.34)%and(96.88±1.75)%,respectively,which were higher than those of the management model,the difference was statistically significant(t=2.663,2.801,2.858,4.111,3.548,P＜0.05)The effective ratio of DEA in the comprehensive evaluation of the medical equipment procurement declaration level,process level,use level and disposal level under the hierarchical management model were 96.7%,98.6%,94.6%and 99.7%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(x2=10.983,9.327,7.270,12.309,P＜0.05).The satisfaction of clinical departments with the procurement and use of medical equipment under the hierarchical management model were(95.82±2.83)%and(97.25±1.96)%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(t=5.575,5.248,P＜0.05).Conclusion:The hierarchical management model can effectively implement the performance objectives of medical equipment procurement,improve the management quality of medical equipment procurement process,improve satisfaction of clinical departments and management personnel after procurement,and ensure the quality of equipment operation.

Objective:To explore the drugs and clinical characteristics causing drug-induced liver injury (DILI) in recent years, as well as identify drug-induced liver failure, and chronic DILI risk factors, in order to better manage them timely.Methods:A retrospective investigation and analysis was conducted on 224 cases diagnosed with DILI and followed up for at least six months between January 2018 and December 2020. Univariate and multivariate logistic regression analyses were used to identify risk factors for drug-induced liver failure and chronic DILI.Results:Traditional Chinese medicine (accounting for 62.5%), herbal medicine (accounting for 84.3% of traditional Chinese medicine), and some Chinese patent medicines were the main causes of DILI found in this study. Severe and chronic DILI was associated with cholestatic type. Preexisting gallbladder disease, initial total bilirubin, initial prothrombin time, and initial antinuclear antibody titer were independent risk factors for DILI. Prolonged time interval between alkaline phosphatase (ALP) and alanine aminotransferase (ALT) falling from the peak to half of the peak (T 0.5ALP and T 0.5ALT) was an independent risk factor for chronic DILI [area under the receiver operating characteristic curve (AUC)?=?0.787, 95%CI: 0.697~0.878, P ?

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the efficacy of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects who were previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extended or switched TMF treatment for 48 weeks. Efficacy was evaluated based on virological, serological, biological parameters, and fibrosis staging. Statistical analysis was performed using the McNemar test, t-test, or Log-Rank test according to the data. Results:593 subjects from the initial TMF group and 287 subjects from the TDF group were included at week 144, with the proportions of HBV DNA<20 IU/ml at week 144 being 86.2% and 83.3%, respectively, and 78.1% and 73.8% in patients with baseline HBV DNA levels ≥8 log10 IU/ml. Resistance to tenofovir was not detected in both groups. For HBeAg loss and seroconversion rates, both groups showed a further increase from week 96 to 144 and the 3-year cumulative rates of HBeAg loss were about 35% in each group. However, HBsAg levels were less affected during 96 to 144 weeks. For patients switched from TDF to TMF, a substantial further increase in the alanine aminotransferase (ALT) normalization rate was observed (11.4%), along with improved FIB-4 scores.Conclusion:After 144 weeks of TMF treatment, CHB patients achieved high rates of virological, serological, and biochemical responses, as well as improved liver fibrosis outcomes. Also, switching to TMF resulted in significant benefits in ALT normalization rates (NCT03903796).

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the safety profile of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects that previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extending or switching TMF treatment for 48 weeks. Safety profiles of kidney, bone, metabolism, body weight, and others were evaluated.Results:666 subjects from the initial TMF group and 336 subjects from TDF group with at least one dose of assigned treatment were included at week 144. The overall safety profile was favorable in each group and generally similar between extended or switched TMF treatments from week 96 to 144. In subjects switching from TDF to TMF, the non-indexed estimated glomerular filtration rate (by non-indexed CKD-EPI formula) and creatinine clearance (by Cockcroft-Gault formula) were both increased, which were (2.31±8.33) ml/min and (4.24±13.94) ml/min, respectively. These changes were also higher than those in subjects with extending TMF treatment [(0.91±8.06) ml/min and (1.30±13.94) ml/min]. Meanwhile, switching to TMF also led to an increase of the bone mineral density (BMD) by 0.75% in hip and 1.41% in spine. On the other side, a slight change in TC/HDL ratio by 0.16 (IQR: 0.00, 0.43) and an increase in body mass index (BMI) by (0.54±0.98) kg/m 2 were oberved with patients switched to TMF, which were significantly higher than that in TMF group. Conclusion:CHB patients receiving 144 weeks of TMF treatment showed favorable safety profile. After switching to TMF, the bone and renal safety was significantly improved in TDF group, though experienceing change in metabolic parameters and weight gain (NCT03903796).

Objective To investigate the clinical features and risk factors for deep vein thrombosis(DVT)of the lower ex-tremities in burn patients.Methods The clinical data of 155 burn patients admitted to Wuhan Third Hospital from January 2021 to January 2023 were retrospectively analyzed.The patients were divided into DVT group and non-DVT group according to whether they had concurrent DVT during hospitalization.Two groups of baseline data were compared[sex,age,body mass in-dex(BMI),coexisting diseases,smoking,drinking,DVT history of the lower limbs,burn cause,burn site,burn degree,central venous catheter retention in the femoral vein,wound infection,low-molecular-weight heparin application,time in bed,and labora-tory indicators[D-dimer(D-d),fibrinogen(FIB),homocysteine(Hey)].The levels of tumor necrosis factor α(TNF-α)and C-reac-tive protein(CRP)differed,and the risk factors for DVT in burn patients were determined via multivariate logistic regression a-nalysis.Finally,this study analyzed the value of BMI,time in bed,D-dimer,fibrinogen,Hcy,TNF-α,and CRP in predicting DVT in burn patients via receiver operating characteristic(ROC)curves.Results There were no significant differences between the two groups in terms of sex,combined disease,smoking or drinking,or cause of burn(all P＞0.05).The following risk factors were found to be significantly greater in the group with deep vein thrombosis(DVT)than in the group without DVT:age 60 years or older,history of lower limb DVT,lower limb burn of degree Ⅱ or above covering 30％or more of the area,femoral vein indentation central venous catheter,wound infection,and lack of low-molecular-weight heparin treatment.Additionally,BMI,D-dimer levels,fibrinogen levels(FIB),homocysteine(Hcy)levels,TNF-α levels,and C-reactive protein(CRP)levels were signifi-cantly higher in the DVT group than in the non-DVT group.The time in bed was significantly longer in the DVT group than in the non-DVT group(P＜0.01).Multivariate logistic regression analysis confirmed that the risk factors for DVT in burn pa-tients included age ≥60 years,history of lower extremity DVT,lower extremity burn,burn degree Ⅱ or above,burn area≥30％,femoral vein indwelling central venous catheter,wound inf ection,lack of low-molecular-weight heparin application,increased BMI,elevated levels of D-dimer,FIB,Hcy,TNF-α,and CRP,and prolonged time in bed.ROC analysis confirmed that BMI,time in bed,D-d,FIB,Hcy,TNF-α and CRP could all be used to predict DVT in burn patients,and the areas under the curve were 0.844,0.853,0.890,0.817,0.892,0.962 and 0.776,respectively,(all P＜0.01).Conclusion Burn patients complicated with DVT are affected by many factors.Moreover,ROC analysis confirmed that BMI,time in bed,D-d,FIB,Hcy,TNF-α and CRP could be indicators for predic-ting DVT,which should be considered in the subsequent clinical treatment of such patients.