Objective:To explore the effect of family empowerment model on the improvement of swallowing care ability and care preparedness of primary caregivers of first-episode stroke dysphagia patients, further to explore its impact on patients′s wallowing function and life quality.Methods:This study was a randomized controlled study. From January 2021 to December 2022, 80 main caregivers of patients with dysphagia caused by manual stroke admitted to the Department of Acupuncture and Moxibustion, Shenzhen Hospital of Traditional Chinese Medicine were selected as the research objects, and 40 cases in the control group and 40 cases in the observation group were selected by random number table method. The control group were treated with conventional nursing care of first-episode stroke dysphagia patients in the acupuncture and moxibustion Department. On the basis of the conventional care in the control group, the observation group were treated with family empowerment model intervention for 14 days and was followed up for 28 days. Primary caregivers′ swallowing care ability, Caregiver Preparedness Scale (CPS), patients′ swallowing function rate, Swallowing Related Quality of Life (SWALQOL) were used to evaluate the effects before intervention and at the end of intervention.Results:There were 18 males and 19 females primary caregivers in the control group, aged (55.61 ± 7.43) years old. There were 18 males and 21 females primary caregivers in the observation group, aged (58.23 ± 8.22) years old. The swallowing care ability score showed a statistically significant difference between the observation group (143.47 ± 3.96) and the control group (107.74 ± 1.43) ( t=-26.76, P<0.05). After intervention, the caregiver preparedness scale was (26.11 ± 3.81) in the observation group, and (18.35 ± 4.54) in the control group, and the difference was statistically significant ( t=-4.11, P<0.05).The patients′ swallowing function rate and SWALQOL score were respectively 97.44% (38/39) and (91.41 ± 8.08) points in the observation group, and 72.97% (27/37) and (80.33 ± 4.21) points in the control group, and the difference was both statistically significant ( χ2=10.76, t=-2.54, both P<0.05). Conclusions:The implementation of family empowerment model could enhance the swallowing care ability and care preparedness of primary caregivers of the first-episode stroke dysphagia patients, which could further improve patients′ swallowing function and life quality.

Objective:To systematically review the predictive model for de novo stress urinary incontinence (de novo SUI) after pelvic organ prolapse (POP) surgery, with the aim of providing reference for preventing the occurrence of de novo SUI.Methods:Literature on the prediction model of de novo SUI after POP surgery was electronically retrieved in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang, and VIP. The search period was from the establishment of the database to December 31, 2023, and the language was limited to Chinese and English. Two researchers independently screened literature, extracted data, and used the prediction model risk of bias assessment tool (PROBAST) to evaluate the quality of the models.Results:A total of 13 articles were included, including 13 de novo SUI risk prediction models. One literature was a prospective study, one literature was a secondary analysis of data, and the rest were retrospective studies. The area under the receiver operating characteristic curve in nine models ranged from 0.595 to 0.842, and the C-index of three models ranged from 0.710 to 0.738. Five models were not validated or only internally validated after construction. Six models were validated in one external population. The predictive performance of one model was validated in six external populations. The overall applicability of the 13 prediction models was good, but there was a certain risk of bias in all of them. Conclusions:There is a significant difference in the predictive performance of the de novo SUI risk prediction model after POP surgery, and the number is relatively small, indicating that it is still in the development stage. Future research should continuously optimize existing models and conduct external validation, and construct predictive models suitable for postoperative de novo SUI in POP patients in China.

Objective:To identify the risk factors and to construct a predictive model for early postnatal mortality (with the first 7 days of life) in extremely preterm infants.Methods:This retrospective study involved 244 extremely preterm infants with a gestational age of 22 to 27 weeks and 6 days, born at the Affiliated Hospital of Jining Medical College from January 2017 to December 2022. They were divided into an early survival group ( n=140) and an early mortality group ( n=84), based on survival for ≥7 days after birth. LASSO and logistic regression were used to select risk factors for early mortality. A nomogram predictive model was constructed using the R software program. The goodness-of-fit tests, area under the curve (AUC), calibration curves, and decision curves were used to evaluate its performance and clinical usefulness. Results:LASSO regression and multivariate logistic regression analyses showed that breech delivery ( OR=3.055, 95% CI: 1.125-8.296), intubation in the delivery room ( OR=4.320, 95% CI: 1.328-14.053), diagnosis of grade Ⅲ-Ⅳ neonatal respiratory distress syndrome within 6 h after birth ( OR=11.552, 95% CI: 3.056-43.677), and use of adrenaline in the delivery room ( OR=10.706, 95% CI: 1.454-78.816) were risk factors for early mortality in extremely preterm infants. Conversely, large gestation age ( OR=0.234, 95% CI: 0.125-0.436), antenatal administration of corticosteroids to promote fetal lung maturity ( OR=0.046, 95% CI: 0.014-0.145), and the use of pulmonary surfactant within 6 h after birth ( OR=0.021, 95% CI: 0.004-0.122) were protective factors against mortality. The goodness of fit test of the early death risk nomogram prediction model for extremely preterm infants indicates a good fit ( P=0.702). The AUC of the model was 0.963 (95% CI: 0.943-0.983), with a sensitivity of 0.904 (95% CI: 0.806-0.949), specificity of 0.892 (95% CI: 0.829-0.938), and accuracy of 0.880. Decision curve analysis indicated that a threshold probability>2% would yield a net benefit. Conclusions:Breech delivery, intubation in the delivery room, use of adrenaline in the delivery room, and the diagnosis of grade Ⅲ-Ⅳ neonatal respiratory distress syndrome within 6 h post-birth are independent risk factors for early mortality in extremely preterm infants. Large gestational age, antenatal administration of corticosteroids to promote fetal lung maturity and use of pulmonary surfactant within 6 h after birth are protective factors. The constructed prediction model based on the aforementioned factors can quantitatively, conveniently, and intuitively assess the risk of early mortality in extremely preterm infants.

Objective:To investigate the value of pulse oxygen saturation (SpO 2) monitoring in predicting children with moderate-to-severe obstructive sleep apnea (OSA). Methods:It was a retrospective study involving 341 children with snoring during nighttime sleep who had visited the Children′s Hospital of Soochow University from June 2017 to November 2020 and monitored for polysomnography (PSG) and SpO 2.The SpO 2 parameters mainly included oxygen desaturation index (ODI), oxygen desaturation index ≥3% (ODI3), oxygen desaturation index ≥4% (ODI4), mean pulse blood oxygen saturation (MSpO 2), lowest pulse blood oxygen saturation (LSpO 2), cumulative time spent with blood oxygen saturation below 95%, 92% and 90%(T95, T92 and T90). According to obstructive sleep apnea hypopnea index (OAHI), patients were divided into the snoring and mild OSA group (OAHI≤5 times/h) and moderate-to-severe OSA group (OAHI>5 times/h). Differences in SpO 2 parameters were compared between groups using the Chi- square test and Mann- Whitney U test. Spearman correlation analysis was used to analyze the correlation between SpO 2 parameters and OAHI in all children.The SpO 2 parameters were included in the Logistic regression model.Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficiency of SpO 2 parameters on moderate-to-severe OSA. Results:A total of 341 patients were recruited, including 206 male and 135 female patients with the mean age, body mass index (BMI) and OAHI of 6.0 (4.0, 7.5) years, 16.2 (15.1, 18.0) kg/m 2 and 0.6 (0.1, 3.0) times /h, respectively.There were 283(83.0%) and 58 (17.0%) patients in the snoring and mild OSA group and moderate-to-severe OSA group.The ODI3[0.7 (0.3, 1.4) times/h vs.7.7 (4.4, 12.8) times/h], ODI4[0.4 (0.1, 0.8) times/h vs.5.3 (2.7, 9.1) times/h], T95[1.4 (0.3, 5.3) min vs.13.7 (7.0, 33.5) min], T92[0.1 (0, 0.5) min vs.1.8 (0.9, 6.0) min] and T90[0 (0, 0.1) min vs.0.6 (0.2, 2.2) min] were significantly lower in the snoring and mild OSA group than those of moderate-to-severe group, while LSpO 2[91.0 (89.0, 93.0)% vs.86.5 (82.0, 88.0)%] and MSpO 2[ 97.0 (97.0, 98.0)% vs.96.0 (96.0, 97.0)%] were significantly higher(all P<0.001). All SpO 2 parameters were significantly correlated with OAHI (all P<0.001), and the correlation coefficient between ODI3 and OAHI was 0.660.ODI3 was an independent predictor of moderate-to-severe OSA ( OR=3.117, 95% CI: 1.635-5.945, P=0.001). The area under the ROC curve of ODI3 in predicting the moderate-to-severe OSA was 0.957, and the cut-off value of 3.45 times/h and specificity of 95.4%.MSpO 2 was an independent predictor of moderate-to-severe OSA ( OR=2.917, 95% CI: 1.589-5.354, P=0.001). Conclusions:ODI3 can be used to predict the moderate-to-severe OSA in children.

Objective: To estimate the transmission capacity of influenza clustering in schools and nurseries, and to evaluate the effect of suspension measures, providing a basis for formulating disease management strategies and control measures. Methods: The SEIAR dynamics model was used to simulate the epidemic data, calculating the basic regeneration coefficient R 0 of the epidemic to evaluate the epidemic transmission capacity, and calculating the cumulative incidence rate of the epidemic to evaluate the prevention and control effect of the suspension measures. Results: The basic regeneration coefficient R 0 was 8.44(8.01,8.89) without intervention. There were statistically significant differences in R 0 of influenza epidemic among different types of school(F=9.52, P<0.01). The R 0 of influenza epidemic in primary and secondary schools were higher than that in nurseries(P<0.05). R 0 of influenza A was higher than that of influenza B(t=2.71, P<0.01). R 0 of influenza A(H3) was higher than of influenza B(Victoria)(P<0.05). The cumulative incidence of the outbreaks which were suspended for 4 days and 7 days was significantly lower than that in the non-suspensions(P<0.05). However, there was no significant difference in the cumulative incidence of the outbreaks between the 4-day suspension and the 7-day suspension(P>0.05). Conclusion Transmission capacity of school-based influenza epidemic is high, especially among primary and secondary schools. When the epidemic situation of infected class meets the suspension standard, it is recommended to suspend classes for 4 days.

Objective:To investigate the predictive factors of poor prognosis in children with acute kidney injury (AKI) treated with renal replacement therapy (RRT).Methods:In this retrospective case-control study, the clinical data were collected from 134 pediatric patients (82 male, 52 female) with AKI treated with RRT in six tertiary hospitals from May 2015 to June 2018. According to the serum creatinine level at discharge, the patients were divided into the favorable outcome group and unfavorable outcome group. The data of sex, age, primary diseases, AKI stage, time from diagnosis of AKI to start of RRT (h) and whether to start RRT within 24 hours, urine volume and complications between the two groups were compared. Continuous variables were compared by t test and Mann-Whitney U test, and percentage or proportions were compared by Chi square test. The predictive factors of adverse prognosis were analyzed by using univariate and unconditional binary logistic regression analysis. Results:The average age of the 134 AKI patients was (6±4) years. There were 114 patients (85.0%) in the favorable outcome group and 20 patients (15.0%) in the unfavorable outcome group. No statistically significant differences were found between the two groups in terms of sex (χ 2=2.596, P=0.107), age ( t=0.718, P=0.474), primary disease (χ 2=2.076, P=0.722), AKI stage (χ 2=0.004, P=0.998), time from diagnosis of AKI to start RRT (h) ( P=0.745), whether to start RRT within 24 hours (χ 2=0.016, P=0.899), urine volume (χ 2=3.118, P=0.374), fluid overload (χ 2=0.014, P=0.905), multiple organ dysfunction syndrome (MODS) (χ 2=2.972, P=0.085), acidosis (χ 2=3.204, P=0.073), hyperkalemia (χ 2=2.829, P=0.093), the level of blood urea nitrogen ( t=1.351, P=0.179) and serum creatinine ( P=0.901) at the beginning of RRT. In the unfavorable outcome group, the proportion of patients with mechanical ventilation (45.0% (9/20) vs. 12.3% (14/114), χ 2=12.811, P<0.01) and the incidence of extra organ injury (≥3) (30.0% (6/20) vs. 10.5% (12/114), χ 2=6.365, P=0.041) were higher than those in the favorable outcome group. Logistic regression analysis showed that mechanical ventilation ( OR=12.540, 95 %CI: 3.376-46.577, P<0.01) and hyperkalemia ( OR=4.611, 95 %CI: 1.265-16.805, P=0.021) were the predictive factors of poor prognosis in patients with AKI treated with RRT. Conclusion:Mechanical ventilation and hyperkalemia may predict a poor prognosis in AKI patients treated with RRT.

Objective To campare the diagnostic value of contrast-enhanced ultrasound(CEUS) and International Ovarian Tumor Analysis (IOTA) simple rules in the differential diagnosis of adnexal tumors . Methods For the 101 suspicious malignant adnexal tumors discovered by conventional ultrasound ,IOTA simple rules and CEUS were performed before operation . Tumors were divided into benign ,uncertain and malignant according to IOTA simple rules . Tumors were scored by CEUS according to the membrane integrity ,coating thickness uniformity ,separation enhancement ,enhance strength ( no enhancement ,low enhancement ,equal or high enhancement) ,and enhanced performance( uniform and non-uniform) . The ROC curve was drawn with the pathological results as the gold standard ,and the best boundary value was obtained . Finally ,the diagnostic efficiency of the diagnostic methods were analyzed . Results ①According to the ROC curve analysis ,the area under the curve of IOTA simple rules was 0 .757( P ＝0 .000) . When the uncertainty type was classified as benign ,the random index was 0 .41 ,the sensitivity was 61 .54% ,and the specificity was 79 .59% . When the uncertainty type was classified as malignant ,the random index was 0 .31 ,the sensitivity was 96 .15% ,and the specificity was 34 .69% . When the uncertain types were excluded the Youden index was 0 .77 ,the sensitivity was 76 .19% ,and the specificity was 89 .47% . ②The differences in the membrane integrity , coating thickness uniformity , separation enhancement , enhance strength , enhanced performance between benign and malignant tumors were statistically significant( P ＜ 0 .01) . ③According to the ROC curve analysis ,the area under the curve of CEUS was 0 .914( P ＝ 0 .000) ,cut-off value was 3 score . The Youden index ,sensitivity and specificity of evaluating benign and malignant adnexal tumors were 0 .80 ,78 .85% and 91 .84% respectively . ④ The tumors evaluated as benign by IOTA simple rules was classified as benign . The tumors evaluated as malignant by IOTA simple rules were classified as malignant . The tumors evaluated as uncertain by IOTA simple rules and scored less than or equal to 3 points according to CEUS were classified as benign . The tumors evaluated as uncertain by IOTA simple rules and scored more than 3 points according to CEUS were classified as malignant . According to the ROC curve analysis ,the area under the curve of CEUS combined with IOTA simple rules was 0 .831 ( P ＝0 .000) . The Youden index ,sensitivity and specificity in evaluating benign and malignant adnexal tumors were respectively 0 .66 ,86 .54% and 79 .59% respectively . Conclusions CEUS has a higher diagnostic efficiency than IOTA Simple Rules and the two combined in the diagnosis of adnexal tumors .

Objective To explore the expression of signal-transducing adaptor protein 2 (STAP2) and importin 5 (Ipo5), and the effect of them on skeletal muscle protein turnover. Methods Twelve male Sprague-Dawley rats were divided into control group (n=6) and model group (n=6). The model group established skeletal muscle hypertrophy induced by blood flow restriction. The soleus muscle cells in both groups were cultured in vitro, and those in the model group infected with shRNA lentivirus to make the expression of STAP2 and Ipo5 silencing, over-expression and gene function salvage finally. The expression of STAP2, Ipo5 and myostatin were determined with Western blotting in soleus muscle in both groups.Results The expression of STAP2 increased (t=-11.786, P<0.001), while the expression of Ipo5 and myostatin decreased (t>14.039, P<0.001) in the model groups compared with those in the control group. Under the control group and the model group, and target genes silencing group, overexpressing group and rescuing group, the expression of myostatin increased with STAP2 decrease and Ipo5 increase.Conclusion The expression of STAP2 increasing and Ipo5 decreasing would promote the protein synthesis.

Objective To analyze the predictive factors of fever after percutaneous renal stone surgery,and to provide reference for clinical treatment.Methods A total of 147 patients underwent percutaneous nephrolithotomy in after operation was chosen in the Department of Urology in our hospital from January 2014 to January 2016.According to the existence of fever,patients were divided into fever (n =25,heating rate 17.0％) and control (n =122) groups.Preoperative information were collected,including age,gender,preoperative serum creatinine,stone size and shape,the involvement of calyceal number,water,urine culture results,operative time,blood loss,intraoperative perfusion volume,pyonephrosis,puncture channel length,hospitalization time and other information including intraoperative,postoperative information including fever,and postoperative renal fistula complications if there is information.SPSS 18.0 was used for statistical analysis.Results The fever group stone surface area,CT value affected calyx number,stone shape,stone properties,the involvement of calyceal number,degree of hydronephrosis,operative time,intraoperative blood loss,intraoperative perfusion,hospitalization time,and renal fistula complication rates were higher than the control group (P ＜ 0.05).There were no significant differences between two groups (P ＞0.05).The results of Logistic regression analysis found that the stone surface area (OR =5.19),stone,stone shape (OR =7.86) properties (OR =3.87),operation time (OR =5.68),intraoperative perfusion (OR =5.24),and renal fistula complications (OR =2.65) for the influence factors of fever.Conclusions The stone surface area is large,stone nature infection stones,stone shape for staghorn calculi,longer operation time,and intraoperative perfusion of large renal fistula complications were more prone to postoperative fever in postoperative.

OBJECTIVE: To study the mechanism of tumor necrosis factor( TNF)-α and its receptor( TNFR) signal transduction pathways in regulating cell apoptosis of alveolar macrophage( AM) in coal workers' pneumoconiosis( CWP).METHODS: Twenty-four coal workers with pneumoconiosis at stage Ⅰ were selected as CWP group and four observation subjects exposed to coal were chosen as observation group by using simple random sampling method. The bronchoalveolar lavage fluids of whole-lung lavage of two groups were collected. AMs were separated and purified. Then they were divided into 6 groups: a control group,a superoxide dismutase( SOD) group,a TNF/TNFR group,an anti-TNF-α antibody group,a Caspase-8 suppression group and a nuclear factor-κB( NF-κB) suppression group. The AMs of 6 groups with corresponding treatment were cultivated. After 24 hours,the cells were harvested and proteins extracted. The relative expression of TNF-α,TNFR1,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 protein was detected by Western blotting. RESULTS: The protein relative expression of TNF-α,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 in CWP group was significantly higher than those in the observation group( P < 0. 05). The protein relative expression of TNF-α,TNFR1,Caspase-8,Caspase-3 and NF-κB P50 in the TNF/TNFR group and the anti-TNF-αantibody group was lower than that of the control group( P < 0. 05). The above indexes in the anti-TNF-α antibody group were lower than that of the NF-κB suppression group( P < 0. 05). The protein relative expression of TNFR1,Caspase-8and Caspase-3 in the TNF/TNFR group was higher than that of the SOD group and the Caspase-8 suppression group( P <0. 05). The protein relative expression of TNFR1,Caspase-8 and NF-κB P50 in the TNF/TNFR group was lower than that of the NF-κB suppression group( P < 0. 05). Among the CWP patients,the relative expression of TNFR2 and NF-κB P65 in the TNF/TNFR group was lower than that of the control group( P < 0. 05),and higher than that of the SOD group( P <0. 05). CONCLUSION: AM apoptosis mediated by TNF-α/TNFR/NF-κB signal transduction pathway plays an important role in the occurrence and development of CWP. The TNF-α/TNFR/NF-κB signal transduction pathways inhibited or blocked at different stages can affect the expression of proteins related to AM apoptosis.