Objective To evaluate the application value of superb microvascular imaging(SMI)in pre-dicting ovarian cancer staging.Methods One hundred and thirty-six patients with ovarian cancer who under-went surgical treatment in our hospital from March 2019 to May 2024 were enrolled.Transvaginal,transab-dominal low-frequency,and transabdominal high-frequency two-dimensional grayscale imaging,Color Doppler Flow Imaging(CDFI),and SMI were performed before surgery for staging prediction.Taking surgical-patho-logical staging as the gold standard,the sensitivity,specificity,and accuracy of the combined application of transvaginal SMI,transabdominal low-frequency SMI,and transabdominal high-frequency SMI for predicting ovarian cancer staging were calculated.The receiver operating characteristic(ROC)curve was established,the area under the ROC curve(AUC)was calculated,and the diagnostic efficacy of SMI for predicting ovarian cancer staging was determined.Results The combined application of transvaginal SMI,transabdominal low-frequency SMI,and transabdominal high-frequency SMI for predicting ovarian cancer staging showed that sen-sitivity was 89.35%,92.36%,81.65%,and 83.21%for stages Ⅰ,Ⅱ,Ⅲ,Ⅳ,respectively;specificity was 86.93%,84.29%,83.39%,and 82.88%;accuracy was 92.50%,94.38%,80.15%,and 84.96%;and AUC was 0.799,0.760,0.695,and 0.727.Conclusion SMI has a high application value in predicting the stage of ovarian cancer,especially for stage Ⅰ and stage Ⅱ ovarian cancer.

Objective:To investigate the current status of multidrug-resistant bacteria (MDRO) wound infections in patients with autoimmune bullous diseases (AIBDs), and to analyze their risk factors.Methods:A retrospective study was conducted, and inpatients with AIBDs accompanied by wound infections were collected from Hospital of Dermatology, Chinese Academy of Medical Sciences from January 2020 to December 2022. A descriptive analysis was carried out to analyze the basic characteristics of these patients and pathogenic characteristics of MDRO. Univariate and binary logistic regression models were used to analyze independent risk factors for MDRO infections in patients with AIBDs. Differences between the MDRO infection group and common bacterial infection group were analyzed by using t test, Mann-Whitney U test and chi-square test. Results:Totally, 271 patients with AIBDs accompanied by wound infections were included, including 159 males (58.7%) and 112 females (41.3%), and 142 patients (52.4%) were aged over 60 years. Most patients with AIBDs were diagnosed with pemphigus vulgaris (131 cases, 48.3%), or bullous pemphigoid (99 cases, 36.5%). Bacterial culture was positive in all the patients, and 74 (27.3%) were infected with MDRO; a total of 108 strains of MDRO were detected, with relatively high detection rates of Staphylococcus (82 strains, 75.9%) and Enterobacter (15 strains, 13.9%). Significant differences were observed between the MDRO infection group and the common bacterial infection group in the duration of hospitalization, involved body surface area, proportions of patients self-modificating drug dosage, proportions of patients topically using antibiotic ointments, proportions of patients using immunosuppressants, duration of glucocorticoid use, maximum dose of glucocorticoids and the first albumin level at admission (all P < 0.05), while there were no significant differences in the gender, age, proportions of patients at first hospitalization, types of AIBDs, duration of education, body mass index, disease duration, proportions of smoking patients, proportions of drinking patients, proportions of patients with comorbid chronic diseases, surgical history, prevalence of hypoalbuminemia, prevalence of mucosal involvement, proportions of patients receiving topical glucocorticoids, proportions of patients using biological agents, duration of antibiotic use, and the first total protein level at admission between the two groups (all P > 0.05). Logistic regression analysis showed that the use of topical antibiotic ointments, use of immunosuppressants, maximum dose of glucocorticoids, and self-modification of drug dosage were independent risk factors for MDRO infections (all P < 0.05) . Conclusions:The patients with AIBDs were prone to develop MDRO infections in wounds, and Staphylococcus infections were the most common. The use of topical antibiotic ointments, use of immunosuppressants, high dose of glucocorticoids, and self-modification of drug dosage may increase the risk of infections in patients with AIBDs.

Objective:To correlate peripheral blood hypersensitive C-reactive protein (hs-CRP) with cognitive function in patients with depression.Methods:Seventy-five patients with depression who received treatment in the Second People's Hospital of Lishui from January 2019 to May 2020 were included in the depression group. An additional 50 healthy controls were included in the control group. The MATRICS Consensus Cognitive Battery (MCCB) was used to evaluate participates' cognitive function. Serum hs-CRP level was determined using enzyme-linked immunosorbent assay.Results:Speed of processing, working memory, verbal learning, visual learning and reasoning/problem-solving scores in the depression group were significantly lower than those in the control group ( t = 10.774, 2.774, 9.840, 5.064, 7.915, all P < 0.01). Serum hs-CRP level in the depression group was significantly higher than that in the control group [(13.05 ± 2.94) mL vs. (1.13 ± 0.18) mL, t = 28.595, P < 0.01]. Speed of processing, working memory, verbal learning, visual learning and reasoning/problem-solving scores in patients with moderate and severe depression were significantly lower than those in patients with mild depression. Serum hs-CRP level in patients with moderate and severe depression was (10.41 ± 2.21) mg/L and (25.71 ± 4.04) mg/L, respectively, which was significantly higher than that in patients with mild depression [(3.03 ± 0.49) mg/L, t = 3.015, 3.370; 3.903, 3.441; 3.541, 3.604; 4.503, 4.661; 4.001, 3.980; 4.035, 3.669, all P < 0.01]. Speed of processing, working memory, verbal learning, visual learning and reasoning/problem-solving scores in patients with severe depression were significantly lower than those in patients with moderate depression ( t = 8.331, 5.227, 10.031, 6.003, 9.416, all P < 0.01). Serum hs-CRP level in patients with severe depression was significantly higher than that in patients with moderate depression [(25.71 ± 4.04) mg/L vs. (10.41 ± 2.21) mg/L, t = 11.005, P < 0.01]. Pearson correlation analysis showed that serum hs-CRP level in patients with depression was remarkably negatively correlated with speed of processing, working memory, verbal learning, visual learning and reasoning/problem-solving scores (all P < 0.01). Conclusion:Serum hs-CRP level in patients with depression is greatly increased, can reflect the severity of depression and is related to cognitive function.

Humans ; Hypogonadism/drug therapy* ; Male ; Puberty ; Puberty, Delayed ; Treatment Outcome

AIM: To investigate the guiding role of individualized medication adjustment based on CYP2C19 metabolic typing in the treatment of ischemic stroke with clopidogrel, and to provide reference for clinical individualized medication. METHODS: The total of 80 patients with ischemic stroke were divided into the individualized drug instruction group with gene detection (n=40) and the control group without gene detection (n=40) according to whether they received CYP2C19 gene detection. According to the metabolism of CYP2C19, the individualized medication instruction group was divided into slow metabolic type, intermediate metabolic type, fast metabolic type and ultra-fast metabolic type. Patients with fast and ultra-fast metabolites were given clopidogrel dose of 75 mg once a day. Patients with intermediate metabolic type were given double clopidogrel dose of 150 mg once a day. Patients with slow metabolism were given tigrillo dose of 90 mg twice a day or aspirin dose of 100 mg once a day. The control group received 75 mg clopidogrel once a day. All patients enrolled in the groups were followed up for 3 months by outpatients or telephone. The incidence of vascular events and mRS scale scores were compared between the two groups. RESULTS: The incidence of vascular events in the individualized drug instruction group was significantly lower than that in the control group, and the incidence of mRS score(0-1) was significantly higher than that in the control group, with statistically significant differences (P<0.05). CONCLUSION: The individualized medication for patients with ischemic stroke by CYP2C19 gene detection can significantly reduce the incidence of adverse vascular events and improve the prognosis and living ability of patients.

Liver fibrosis, liver cirrhosis and hepatocellular carcinoma caused by chronic hepatitis B are still the main diseases that seriously affect the health of Chinese population. Notably, even if serum HBV-DNA cannot be detected after treatment, many patients will still develop liver disease. Therefore, in addition to the quantitative analysis of HBV-DNA and HBsAg, other new serological markers should be sought to facilitate the selection of CHB antiviral drugs and methods, monitoring efficacy and follow-up, efficacy prediction, and the risks of viral rebound after drug withdrawal. This article focuses on three new serological markers, namely HBcrAg, HBV-RNA and anti-HBc, with a view to applying them in clinical practice.

Objective:To explore the nutritional risk status and related factors of elderly inpatients.Methods:Using the convenient sampling method, 321 elderly stroke patients who were hospitalized in the neurology department of a ClassⅢ Grade A hospital from April to October 2018 were selected as the research objects for nutritional risk screening. Serum albumin (ALB) , serum prealbumin (PA) and other related nutritional indexes were recorded, and ADL, tooth, cognition, psychology and sleep of the patients were evaluated.Results:A total of 31.5% (101/321) of elderly stroke patients had nutritional risk. Among elderly stroke patients over 70 years old, 13.39% (43/321) had NRS-2002 ≥ 3 points. There were statistically significant differences in the incidence of nutritional risk among elderly stroke patients of different ages and degrees of dysphagia ( P<0.01) . Correlation analysis showed that the nutritional risk of elderly stroke patients was related to swallowing disorder, activity of daily living, intelligent mental state, and depression state ( P<0.05) . Conclusions:The older the elderly stroke patients, the higher the incidence of nutritional risk. Age, dysphagia, activity of daily living, BMI, intelligent mental state and depression are related to nutritional status, which should be paid attention to by medical staff and timely nutritional intervention should be given.

Objective: To analyze serum HBV-RNA levels in patients with chronic hepatitis B whose serum HBV-DNA has dropped to undetected levels after treatment with entecavir, and to explore the correlation between HBV-RNA level and liver biochemical parameters, which lay the research foundation for the clinical significance of new serological marker HBV-RNA. Methods: HBeAg negatively detected 107 cases with chronic hepatitis B whose serum HBV-DNA test results were lower than detection level for six consecutive months after receiving standard nucleoside therapy for more than 12 months were included. HBV-RNA level was detected by Perkin-Elmer reagent. HBV-DNA level was detected by Roche Cobas. Hitachi automatic biochemical analyzer was used to detect ALT and AST. Architect chemiluminescence analyzer was used to detect HBsAg, HBeAg, anti-HBe and anti-HBc. RStudio software was performed to analyze the correlation between HBV-RNA level and liver biochemical parameters. Logistic regression was used to analyze the independent factors influencing HBV-RNA level. Results: The positive detection rate of serum HBV-RNA in patients with chronic hepatitis B whose serum HBV-DNA had dropped to undetected levels after ETV treatment was 22.43%. HBsAg, ALT and AST levels in HBV-RNA positive group were slightly higher than HBV-RNA negative group, while anti-HBc levels were slightly higher in HBV-RNA negative group. There was no difference in the level of anti-HBe between the HBV-RNA negative and the positive group. Logistic regression analysis showed that anti-HBc was an independent factor influencing the level of HBV-RNA detection (P = 0.021). Conclusion HBV-RNA can be detected in some patients with chronic hepatitis B whose serum HBV-DNA level has dropped to undetected levels after ETV treatment. Serum HBV-RNA only comes from the direct transcription of cccDNA, so it is better than HBV-DNA and HBsAg to reflect cccDNA level or activity. Anti-HBc, as an independent factor influencing the level of HBV-RNA, may be used in combination as a new marker to predict the efficacy of antiviral therapy.

Objective: To evaluate the in vitro antibiotic effects of colistin combined with meropenem, levofloxacin or fosfomycin against colistin-heteroresistant Acinetobacter baumannii (A.baumannii). Methods: A total of 576 A. baumannii clinical isolates were collected from the First Affiliated Hospital of Wenzhou Medical University from 2014 to 2015. Minimal inhibitory concentrations (MICs) of colistin against A. baumannii were detected by broth dilution method. Colistin-heteroresistant A. baumannii isolates were screened using population analysis profiles (PAPs). MICs of colistin combined with meropenem, levofloxacin or fosfomycin, and the four drugs used alone against colistin-heteroresistant A. baumannii were detected by checkerboard method and broth dilution method. Fractional inhibitory concentration index (FICI) was calculated to evaluate antibiotic effects. Results: None of the 576 A. baumannii isolates was resistant to colistin as indicated by the broth dilution method. Nine colistin-heteroresistant A. baumannii isolates were identified using PAPs. Compared with the MICs of colistin used alone, the MICs of colistin used in combination with meropenem, levofloxacin or fosfomycin against colistin-heteroresistant isolates were all decreased. Colistin-meropenem combination showed synergistic (55.6%), additive (33.3%) and indifferent effects (11.1%), but no antagonistic effect. Colistin-levofloxacin combination showed synergistic (55.6%), additive (22.2%) and indifferent effects (22.2%), but no antagonistic effect. Colistin-fosfomycin combination showed synergistic (77.8%) and additive (22.2%) effects, but no indifferent or antagonistic effect. Conclusion In vitro use of colistin in combination with meropenem, levofloxacin or fosfomycin has synergistic and additive antibacterial effects against colistin-heteroresistant A. baumannii. Combinations of colistin-meropenem and colistin-levofloxacin have fewer indifferent effects and no antagonistic effect.

Objective To investigate the transitional care needs of ischemic stroke patients when they were discharged and analyze the influencing factors.Methods Transitional care needs of stroke patients questionnaires were conducted in 136 ischemic stroke patients in the department of neurology from April 2014 to December 2014.Results Telephone follow-up was the easiest way of transitional care to be accepted by patients. The transitional care needs included five aspects:safe medication(86.0%),blood pressure self monitoring(83.1%),diet guiding(83.1%),rehabilitating exercise(80.1%) and stroke knowledge(75.7%). The influencing factors of transitional care needs were:the patients with previous medical history demanded much more on the safe medication intervention than the patients without history disease. The demand of the patients with previous medical history was 7.17 times as much as that of the patients without previous medical history (OR=7.15,95%CI:1.83-27.94).The demand of the patients with previous medical history on "rehabilitation exercise" was 4.68 times as much as that of the patients without previous medical history (OR=4.68,95%CI:1.40-15.63). The demand of the patients over 60 years old on "diet guiding" was 11.41 times as much as patients under 50 years old (OR=11.41,95%CI:1.75-74.46).Conclusions For ischemic stroke patients,telephone follow-up can be used as the method of transitional care. Older patients and patients with previous medical history are the main patients who need transitional care.