Objective:To explore the risk factors for malnutrition after a traumatic brain injury and to construct a model which usefully predicts that risk.Methods:This was a retrospective study of 374 patients with a craniocerebral injury for whom the relevant clinical data were available. Based on their nutritional status, they were stratified into a malnutrition group ( n=220) and a control group ( n=154). Univariate and multivariate logistic regressions were evaluated seeking to identify the independent risk factors associated with malnutrition, and a prediction model was constructed based on the results. The model′s discrimination ability and accuracy were assessed using a receiver operating characteristics (ROC) curve. Results:A total of 220 patients (58.8%) developed malnutrition. Multifactorial logistic regression analysis showed that the independent risk factors for malnutrition were: age ≥60 years, pulmonary infection, dysphagia, cognitive impairment, a GCS score ≤8, or a Barthel index ≤40. In the ROC curve analysis, the area under the curve quantifying the model′s ability to predict malnutrition was 0.924 (95% CI: 0.896, 0.951), with a sensitivity of 0.868 and a specificity of 0.857, indicating its good prediction performance. Conclusions:Age ≥60 years, pulmonary infection, dysphagia, cognitive impairment, a GCS score ≤8 or a Barthel index ≤40 are independent predictors of malnutrition after a traumatic brain injury. The prediction model constructed based on those risk factors has demonstrated useful predictive power for malnutrition.

Objective:To evaluate the application effect and long-term benefits of in situ simulation combined with the forgetting curve training mode in trauma nurse training, and to provide a basis for further promoting the development of trauma nurse training.Methods:From June to September 2022, a total of 78 nurses in the Trauma Center of a grade A tertiary hospital in Changsha, China were selected by the purposive sampling method as the research objects. The nurses were divided into an experimental group and a control group according to the random number table method. The control group received theoretical teaching and skill operation training by traditional teaching methods. The experimental group was trained by the teaching method of in-situ simulation combined with the forgetting curve. The scores of theoretical and operational skills of the two groups were compared by the repeated measures analysis of variance (ANOVA) before training (T1), 1 day after training (T2), 1 month after training (T3), and 6 months after training (T4). The scores of core competence of trauma nurses before and after training were compared between the two groups by the t test. Results:There was no significant difference in theoretical, operational, and core competence scores between the two groups before training ( P>0.05). The results of repeated measures ANOVA showed significant differences in the time effect, inter-group effect, and interaction effect of theoretical and operational scores between the two groups ( P<0.001). The results of one-way repeated measures ANOVA showed that the theoretical and operational scores of the two groups increased first and then decreased with time. The results of multivariate ANOVA showed no significant difference in theoretical and operational scores between the two groups at observation time point T1 ( P>0.05), but significant differences at observation time points T2, T3, and T4, at which the scores in the experimental group were higher than those in the control group ( P<0.001). The results of independent samples t test showed that the core competence score of trauma nurses in the experimental group was significantly higher than that in the control group after training ( P<0.05). Conclusions:The training mode of in situ simulation combined with the forgetting curve is more effective than traditional training mode in improving the professional skill level of trauma nurses and brings long-term training effect and benefits.

Objective:To evaluate the effect of ultrasound-guided internal branch block of superior laryngeal nerve on stress response during endotracheal catheter indwelling in patients undergoing uvulopalatopharyngoplasty (UPPP).Methods:A total of 80 patients with severe obstructive sleep apnea syndrome requiring elective UPPP from the Hunan Provincial People′s Hospital from January 2020 to December 2021 were retrospectively selected and divided into nerve block group (group B) and dexmedetomidine group (group D). Patients in group B and D received general anesthesia. Patients in the group B received bilateral internal branch block of superior laryngeal nerve under ultrasound guidance before postoperative recovery. Patients in the group D received dexmedetomidine intravenously before the end of surgery. The cough scores and mean arterial pressure (MAP), heart rate (HR), plasma epinephrine (E) and norepinephrine (NE) levels of patients before anesthesia (T 1), immediately after recovery (T 2), 2 h after recovery (T 3), 6 h (T 4), and 12 h (T 5) during endotracheal catheterization were recorded in both groups. The Visual Analogue Scale (VAS) scores of T 2, T 3, T 4, T 5 and 24 h after surgery (T 6) were also obtained. Results:Compared with group D, the cough scores of the group B patients were significantly lower, and the number of cases requiring remedial analgesia was significantly less (all P<0.01). Compared with T 1, MAP and HR at T 2-T 5 time points in the group B and HR and MAP at T 2-T 5 time points in the group D were significantly increased (all P<0.05). Compared with the group D, MAP and HR were significantly higher than those at each time point of T 2-T 5 in the group B (all P<0.05). Compared with T 1, the serum NE and E levels in the group D at T 2-T 5 time points, and the serum NE and T 2 E levels in the group B at T 2-T 5 time points were increased, and the differences were statistically significant (all P<0.05). Compared with the group D, serum E and serum NE levels at T 2-T 5 and T 2-T 4 in the group B were significantly lower (all P<0.05). Compared with T 2, T 5-T 6 VAS scores in the group B and T 3-T 6 VAS scores in the group D were significantly decreased (all P<0.05). Compared with the group D, the VAS scores at T 2-T 5 time points in the group B were significantly lower (all P<0.05). Conclusions:Compared with intravenous use of dexmedetomidine, ultrasound-guided internal branch block of superior laryngeal nerve can significantly reduce the discomfort and stress response during catheterization after UPPP, increase the comfort level of patients, reduce the incidence of postoperative complications, and promote rapid recovery of patients.

Objective:To evaluate the application effect and long-term benefits of in situ simulation combined with the forgetting curve training mode in trauma nurse training, and to provide a basis for further promoting the development of trauma nurse training.Methods:From June to September 2022, a total of 78 nurses in the Trauma Center of a grade A tertiary hospital in Changsha, China were selected by the purposive sampling method as the research objects. The nurses were divided into an experimental group and a control group according to the random number table method. The control group received theoretical teaching and skill operation training by traditional teaching methods. The experimental group was trained by the teaching method of in-situ simulation combined with the forgetting curve. The scores of theoretical and operational skills of the two groups were compared by the repeated measures analysis of variance (ANOVA) before training (T1), 1 day after training (T2), 1 month after training (T3), and 6 months after training (T4). The scores of core competence of trauma nurses before and after training were compared between the two groups by the t test. Results:There was no significant difference in theoretical, operational, and core competence scores between the two groups before training ( P>0.05). The results of repeated measures ANOVA showed significant differences in the time effect, inter-group effect, and interaction effect of theoretical and operational scores between the two groups ( P<0.001). The results of one-way repeated measures ANOVA showed that the theoretical and operational scores of the two groups increased first and then decreased with time. The results of multivariate ANOVA showed no significant difference in theoretical and operational scores between the two groups at observation time point T1 ( P>0.05), but significant differences at observation time points T2, T3, and T4, at which the scores in the experimental group were higher than those in the control group ( P<0.001). The results of independent samples t test showed that the core competence score of trauma nurses in the experimental group was significantly higher than that in the control group after training ( P<0.05). Conclusions:The training mode of in situ simulation combined with the forgetting curve is more effective than traditional training mode in improving the professional skill level of trauma nurses and brings long-term training effect and benefits.

Objective:To evaluate the effect of ultrasound-guided internal branch block of superior laryngeal nerve on stress response during endotracheal catheter indwelling in patients undergoing uvulopalatopharyngoplasty (UPPP).Methods:A total of 80 patients with severe obstructive sleep apnea syndrome requiring elective UPPP from the Hunan Provincial People′s Hospital from January 2020 to December 2021 were retrospectively selected and divided into nerve block group (group B) and dexmedetomidine group (group D). Patients in group B and D received general anesthesia. Patients in the group B received bilateral internal branch block of superior laryngeal nerve under ultrasound guidance before postoperative recovery. Patients in the group D received dexmedetomidine intravenously before the end of surgery. The cough scores and mean arterial pressure (MAP), heart rate (HR), plasma epinephrine (E) and norepinephrine (NE) levels of patients before anesthesia (T 1), immediately after recovery (T 2), 2 h after recovery (T 3), 6 h (T 4), and 12 h (T 5) during endotracheal catheterization were recorded in both groups. The Visual Analogue Scale (VAS) scores of T 2, T 3, T 4, T 5 and 24 h after surgery (T 6) were also obtained. Results:Compared with group D, the cough scores of the group B patients were significantly lower, and the number of cases requiring remedial analgesia was significantly less (all P<0.01). Compared with T 1, MAP and HR at T 2-T 5 time points in the group B and HR and MAP at T 2-T 5 time points in the group D were significantly increased (all P<0.05). Compared with the group D, MAP and HR were significantly higher than those at each time point of T 2-T 5 in the group B (all P<0.05). Compared with T 1, the serum NE and E levels in the group D at T 2-T 5 time points, and the serum NE and T 2 E levels in the group B at T 2-T 5 time points were increased, and the differences were statistically significant (all P<0.05). Compared with the group D, serum E and serum NE levels at T 2-T 5 and T 2-T 4 in the group B were significantly lower (all P<0.05). Compared with T 2, T 5-T 6 VAS scores in the group B and T 3-T 6 VAS scores in the group D were significantly decreased (all P<0.05). Compared with the group D, the VAS scores at T 2-T 5 time points in the group B were significantly lower (all P<0.05). Conclusions:Compared with intravenous use of dexmedetomidine, ultrasound-guided internal branch block of superior laryngeal nerve can significantly reduce the discomfort and stress response during catheterization after UPPP, increase the comfort level of patients, reduce the incidence of postoperative complications, and promote rapid recovery of patients.

Objective:To explore the risk factors for malnutrition after a traumatic brain injury and to construct a model which usefully predicts that risk.Methods:This was a retrospective study of 374 patients with a craniocerebral injury for whom the relevant clinical data were available. Based on their nutritional status, they were stratified into a malnutrition group ( n=220) and a control group ( n=154). Univariate and multivariate logistic regressions were evaluated seeking to identify the independent risk factors associated with malnutrition, and a prediction model was constructed based on the results. The model′s discrimination ability and accuracy were assessed using a receiver operating characteristics (ROC) curve. Results:A total of 220 patients (58.8%) developed malnutrition. Multifactorial logistic regression analysis showed that the independent risk factors for malnutrition were: age ≥60 years, pulmonary infection, dysphagia, cognitive impairment, a GCS score ≤8, or a Barthel index ≤40. In the ROC curve analysis, the area under the curve quantifying the model′s ability to predict malnutrition was 0.924 (95% CI: 0.896, 0.951), with a sensitivity of 0.868 and a specificity of 0.857, indicating its good prediction performance. Conclusions:Age ≥60 years, pulmonary infection, dysphagia, cognitive impairment, a GCS score ≤8 or a Barthel index ≤40 are independent predictors of malnutrition after a traumatic brain injury. The prediction model constructed based on those risk factors has demonstrated useful predictive power for malnutrition.

Objective To analyze the experience of Professor Chen Huanchao,a famous TCM doctor in Hubei Province,in treating breast cancer by data mining technology.Methods The medical records of Professor Chen Huanchao's treatment of breast cancer were collected,and the first prescription of each patient was recorded after screening and sorting.MS Excel 2019 was used to analyze drug frequency,efficacy frequency,and the meridian distribution,and SPSS Modeler 18.0 software was adopted for association rule analysis and network display of drugs.SPSS 27.0 was employed for clustering analysis of high-frequency drugs to summarize medication patterns.Results A total of 185 prescriptions involving 180 traditional Chinese medicines were included,and 29 high-frequency drugs were screened.The medicinal properties were mainly neutral,cold,and warm,and the medicinal flavors were mainly sweet,bitter,and pungent.The meridians were liver,lung,spleen,and kidney meridians.The medicinal effects primarily included tonifying deficiency,clearing heat,and promoting diuresis and dampness.The association rule analysis showed 20 groups of drug pairs,and the cluster analysis mainly revealed two categories.Conclusion Professor Chen Huanchao believes that breast cancer involves root deficiency and excessive symptoms and should be treated from the perspective of"deficiency,blood stasis,phlegm,and toxin."Genuine-Qi should be strengthened,and Evil-Qi should be eliminated.The symptoms and root causes of this disease should be treated simultaneously while soothing the liver and qi,tonifying the spleen and kidney,promoting blood circulation,removing phlegm and preventing its accumulation,and clearing heat and detoxify.This work provides ideas for the treatment of breast cancer with traditional Chinese medicine.

Influenza is a worldwide infectious disease caused by influenza virus. It has posed great challenges on public health and social stability since 1918. At present, vaccination is the most effective way to prevent and control influenza epidemics. Broad-spectrum antiviral drugs and neutralizing antibodies against influenza virus have been widely studied in recent years. Hemagglutinin (HA), which is on the surface of influenza virus, plays an important role in the stage of viral invasion into host cells. It is the main effective antigenic component of current influenza vaccines, as well as the main target of broad-spectrum neutralizing antibodies and broad-spectrum antiviral drugs. This review summarized the progress in the development of novel influenza vaccines, neutralizing antibodies, and antiviral drugs based on influenza virus HA, as well as other prevention and control measures, hoping to present new ideas for future influenza prevention and control.

Objective:To evaluate the immunogenicity of Madin-Darby canine kidney (MDCK) cell-based quadrivalent influenza split vaccine (MDCK-Va) combined with different adjuvants.Methods:Different doses of MDCK-Va and chicken embryo-based quadrivalent influenza split vaccine (egg-Va) were intramuscularly immunized BALB/c mice twice with an interval of three weeks. Serum samples were collected to detect antibody titers using hemagglutination inhibition (HI) assay. BALB/c mice were immunized with different doses of MDCK-Va combined with QS21, AddVax, PolyI∶C, CpG ODN 1826 and AddVax/PolyI∶C (Add/Poly), respectively. HI and microneutralization assays were used to detect antibody titers 21 d after the first and booster immunization. Spleen tissues were collected from the mice immunized with 10 μg MDCK-Va combined with the above adjuvants 5 d after the booster immunization to analyze spleen index and the types of spleen cells.Results:The immunoprotective effect of MDCK-Va was not inferior to that of egg-Va. MDCK-Va combined with each of the above adjuvants could induce higher HI antibody titer than MDCK-Va alone, especially the QS21/Va and Add/Poly/Va groups, and the differences were statistically significant. For H1N1 vaccine, the Pearson′s correlation coefficient ( r) between HI antibody and neutralizing antibody was 0.737-0.910, and for H3N2 subtype vaccine, the value of r was 0.839-0.947. Compared with the MDCK-Va group, the QS21/Va group showed significantly increased spleen index and decreased proportion of single lymphocytes. QS21 and Add/Poly were much better than other adjuvants in stimulating mouse splenic neutrophils and CD4/CD8 cells. Conclusions:Add/Poly had a stronger immune enhancement effect on MDCK-Va, suggesting that it was a potential adjuvant for MDCK-Va. The antibody titer detected by HI and MN assays had a strong positive correlation.

Objective:To explore the risk factors of acute respiratory distress syndrome (ARDS) secondary to severe multiple trauma and the role of clinical guidance.Methods:The clinical data of 115 patients with severe multiple trauma admitted to the trauma center of Zhenjiang First People's Hospital from December 2017 to September 2020 were retrospectively analyzed. According to whether ARDS occurred within 1 week of the disease course, the patients were divided into ARDS group and non-ARDS group. The basic post-traumatic data, initial treatment measures (within 24 hours), pathophysiology, stress metabolism, and post-traumatic complications of the two groups of patients were selected for univariate analysis, the statistically different indicators of univariate analysis were incorporated into the multivariate Logistic regression analysis to screen out independent high-risk factors that affect the occurrence of ARDS in patients with severe multiple trauma, and a receiver operating characteristic curve (ROC curve) was drawn to analyze the effects of each risk factor on the occurrence of ARDS.Results:Among 115 patients, there were 45 casesin the ARDS group and 70 cases in the non-ARDS group. Compared with the non-ARDS group, the patients in the ARDS group were older (years: 57.45±15.37 vs. 45.68±12.70), and the proportion of patients combined with moderate-severe chest trauma, traumatic brain injury (TBI), shock, and massive blood transfusion were higher (71.11% vs. 31.43%, 44.44% vs. 28.57%, 80.00% vs. 67.14%, 46.67% vs. 27.14%). In the ARDS group, procalcitonin [PCT (μg/L):29.73±6.08 vs. 12.45±2.12], thrombomodulin [TM (ng/L): 83.43±16.34 vs. 37.66±14.64], blood glucose (mmol/L:17.2±5.0 vs. 10.3±2.4), triacylglycerol [TG (mmol/L): 3.77±0.57 vs. 2.22±0.63], interleukin-6 [IL-6 (ng/L):38.97±10.79 vs. 25.98±5.40], tumor necrosis factor-α [TNF-α (ng/L): 48.78±13.99 vs. 35.30±13.03], intra-abdominal pressure [mmHg (1 mmHg = 0.133 kPa): 25.21±3.59 vs. 11.98±4.91], serum creatinine [SCr (μmol/L):180.45±42.35 vs. 132.17±49.36] and blood urea nitrogen [BUN (mmol/L): 13.83±4.97 vs. 8.80±4.32] were significantly higher than those in the non-ARDS group; the proportion of patients with crystal infusion volume ≥ 3 000 mL(26.67% vs. 34.29%) and platelet count [PLT (×10 9/L): 72.67±7.96 vs. 127.99±17.65] and the levels of plasma glutathione peroxidase [GSH-Px (kU/L): 87.15±27.81 vs. 161.15±17.94], plasma superoxide dismutase [SOD (kU/L):92.65±32.67 vs. 125.58±38.96] were significantly lower than those in the non-ARDS group, the differences were statistically significant (all P < 0.05). Multivariate Logistic regression analysis showed that 11 indicators such as age, combined moderate-severe chest trauma, combined TBI, massive blood transfusion, PCT, TM, blood glucose, TNF-α, plasma GSH-Px, intra-abdominal pressure and SCr were independent risk factors that could predict ARDS secondary to severe multiple trauma, the odds ratio ( OR) and 95% confidence interval (95% CI) were 1.201 (1.035-1.165), 3.414 (1.217-8.876), 2.889 (1.124-8.109), 3.134 (1.322-9.261), 1.467 (1.096-2.307), 2.428 (0.024-0.973), 5.787 (1.246-9.642), 1.106 (0.949-5.108), 7.450 (1.587-10.261), 3.144 (1.217-8.876), 1.051 (1.002-1.542) respectively, the P valueswere 0.008, 0.024, 0.044, 0.017, 0.018, 0.045, 0.026, 0.037, 0.005, 0.029, 0.033 respectively. ROC curve analysis showed that plasma GSH-Px had a higher predictive value for ARDS secondary to severe multiple trauma, the area underROC curve (AUC) = 0.873, 95% CI was 0.798-0.928, P = 0.000, when the best cut-off value at 72.22 kU/L, its sensitivitywas 86.7%, specificity was 75.7%, positive predictive value was 69.6%, and negative predictive value was 89.8%. The Logistic regression model established by 11 independent high-risk factors had an accuracy rate of 81.74% in predicting ARDS secondary to severe multiple trauma, which had a good guiding significance for predicting ARDS. Conclusion:Our study showed that there are many risk factors for ARDS secondary to severe multiple trauma, involvingbasic post-traumatic data, initial treatment measures, pathophysiology, stress metabolism, post-traumatic complications, etc. Early identification and intervention may be beneficial to improve the success rate of treatment for such patients.