Objective:To investigate the effect of preoperative use of diuretics on cardiac surgery-associated acute kidney injury(CSA-AKI)in elderly patients.Methods:In this single-center retrospective study, 1 638 patients aged ≥60 years and undergone cardiac surgery(including coronary artery bypass grafting, valve replacement and valvuloplasty)in the Department of Cardiovascular Surgery, Linyi People's Hospital between January 2015 and December 2022 were recruited.The last preoperative serum creatinine(SCr)level was taken as the baseline value, and AKI was diagnosed according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Patients were divided into an AKI group and a non-AKI group according to whether AKI occurred after surgery.The clinical characteristics of the two groups were compared, and the effect of preoperative use of diuretics on CSA-AKI was evaluated by multivariate Logistic regression analysis.Results:Of 1638 patients enrolled in the study, 284 patients(17.3%)developed CSA-AKI.Compared with the non-AKI group, there were higher proportions of patients in the AKI group receiving furosemide(62.7% or 178/284 vs.46.2% or 626/1 354, χ2=25.397, P<0.001), spironolactone(70.1% or 199/284 vs.49.9% or 676/1 354, χ2=38.284, P<0.001), and hydrochlorothiazide(8.1% or 23/284 vs.3.5% or 47/1354, χ2=12.288, P<0.001). The number of diuretics in the AKI group was higher than in the non-AKI group[2(0, 2) vs.1(0, 2), Z=-6.381, P<0.001], and the proportion of patients using ≥2 diuretics was higher in the AKI group than in the non-AKI group(70.1% or 199/284 vs.49.0% or 664/1354, χ2=41.652, P<0.001). Multivariate Logistic regression analysis showed that, after adjusting for hypertension, diabetes mellitus, hypoalbuminemia, NYHA functional class Ⅲ/Ⅳ, cardiopulmonary bypass during surgery, operative duration≥6 h, postoperative blood transfusion>600 ml, postoperative use of >3 vasoactive drugs and other variables, preoperative use of ≥2 diuretics remained an independent risk factor for CSA-AKI in elderly patients( OR=1.580, 95% CI: 1.042-2.396, P=0.031). Conclusions:AKI is a common complication after cardiac surgery in elderly patients.Preoperative use of ≥2 diuretics used may be an independent risk factor for CSA-AKI.

Objective:To explore the value of biphasic quantitative CT on small airway disease and emphysema injury in patients with smoking combined with chronic obstructive pulmonary disease (COPD).Methods:A total of 186 male physical examination subjects who underwent biphasic CT and pulmonary function (PFT) examinations in the Affiliated Hospital of Yan′an University from July 2018 to September 2020 were enrolled in this retrospective study. These subjects were divided into 121 smokers with COPD (COPD group), aged 34 to 84 (64±8) years old and 65 smokers without COPD (non-COPD group) aged 34 to 72 (61±5) years old. According to the guidelines of the COPD global initiative, patients in COPD group were divided into Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) Ⅰ-Ⅳ grades. The original DICOM data of CT were imported into the "Digital Lung" test and analysis platform. Quantitative parameters of functional small airway disease percentage (fSAD%) and emphysema area percentage (Emph%) of each lobe were calculated. The differences of CT quantitative parameters among non-COPD group and each grade in COPD group were analyzed by One-Way ANOVA or Kruskal-Wallis H test. The correlation between the smoking index and CT quantitative parameters was analyzed by Spearman correlation analysis. Results:There were significant differences in fSAD% and Emph% of each lobe among non-COPD group and COPD group GOLD Ⅰ-Ⅳ ( P<0.001). Except that the Emph% in right middle lobe of GOLD grade Ⅰ was higher than that of GOLD grade Ⅱ in COPD group, the fSAD% and Emph% in other lobes increased gradually with the increase of GOLD grade in COPD group. The fSAD% and Emph% were larger in the right middle lobe and both upper lobes of COPD group GOLD Ⅰ-Ⅳ. The comparison among each lobe showed that the differences were statistically significant ( P<0.01), except for the fSAD% and Emph% of GOLD Ⅳ ( P=0.395, 0.840). The smoking index was positively correlated with fSAD% and Emph% in each lung lobe. Among them, smoking index was highly correlated with fSAD% in the lower right lobe and Emph% in the lower left lobe ( r=0.474, 0.619, P<0.001). Conclusion:The biphasic quantitative CT can early and sensitively reflect the degree of small airway disease and emphysema injury in smoking combined with COPD, which is of great significance for the early diagnosis and evolution of COPD.

Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.

OBJECTIVE：To evaluate the economy of pe rospirone in the treatment of schizophrenia ，to provide guidance for clinically proper use of medications more cost-effectively ，and related health decision-making . METHODS ：A short-term decision tree model was constructed from the perspective of medical insurance payer to calculate the cost and health outcomes of different treatment plans considering major adverse events including extrapyramidal reaction ，weight gain ，diabetes，hyperlipidemia. The cost-utility of perospirone were compared with quetiapine ，aripiprazole and olanzapine respectively ，using QALYs as the measure of health outcomes ，3 times GDP per capita as the willingness-to-pay threshold ；probability sensitivity analysis was performed. RESULTS：The results of base-case analysis showed that the cost of perospirone （6 688.25 yuan）was lower than those of quetiapine （9 887.45 yuan），aripiprazole（13 284.65 yuan）and olanzapine （15 332.80 yuan）. The utility of perospirone （0.79 QALYs）was better than those of quetiapine （0.76 QALYs），aripiprazole（0.77 QALYs）and olanzapine （0.75 QALYs）. Compared with quetiapine ， aripiprazole and olanzapine ，peropirone had lower cost and higher health outcome ，which indicated that strong dominance favors perospirone over the other 3 drugs. The results of sensitivity analysis were consistent with those of base-case analysis. CONCLUSIONS：Perospirone has economic advantages in treating schizophrenia patients compared to other commonly used atypical antipsychotic drugs.

Objective To explore the consistency between the Chinese Version of Stressors in Nursing Students (SINS-CHI) and the Student Nurse Stress Index Scale (SNSI-CHI) in assessing the pressure of undergraduate nursing students.Methods A total of 960 nursing undergraduates from three universities in Henan province were randomly selected.SINS-CHI and SNSI-CHI were applied to all subjects and SPSS 21.0 was used to analyze the validity and reliability.Results The total score of SINS-CHI was (112.73± 26.07).The Cronbach's α was 0.926,the Guttman's partial reliability coefficient was 0.893,the test-retest reliability was 0.820,the content validity index (CVI) was 0.890,the sensitivity was 70.0％,and the specificity was 62.3％.The Yoden index was 0.323 and the area under the ROC curve was 0.710.The total score of SNSI-CHI was (58.71± 14.18).The Cronbach's α was 0.893,Guttman split-half reliability coefficient was 0.829,test-retest reliability was 0.966,CVI was 0.954,sensitivity was 71.4％,specificity was 63.6％.The Yoden index was 0.350 and the area under the ROC curve was 0.714.Conclusion The consistency of SINS-CHI and SNSI-CHI is good.

Objective To summarize the clinical characteristics and prognosis of lacrimal gland adenoid cystic carcinoma with high-grade transformation (LACC-HGT).Methods A retrospective study was adopted.Seventeen patients with lacrimal gland adenoid cystic carcinoma (LACC) were collected from August 2008 to March 2017 in Tianjin Medical University Eye Hospital.Hematoxylin-eosin staining and immunohistochemical staining were performed on tumor sections of 17 LACC patients.According to the pathology results,the patients were divided into LACC-HGT group (6 patients) and non-LACC-HGT (NLACC-HGT)group (11 patients),and the clinical characteristics and prognosis of the two groups were analyzed by using Fisher's exact test and Log-Rank test.Results The medical histories,clinical features,imaging features,TNM staging and treatment protocols were not significantly different between the two groups (all at P＞ 0.05).The 2-year local recurrence rate,5-year distant metastasis rate and 5-year death rate of patients with LACC-HGT were significantly higher than patients with NLACC-HGT (all at P＜0.05).Survival analysis results showed that the survival time of LACC-HGT group was obviously shorter than that of NLACC-HGT group.Conclusions LACC-HGT accelerate the invasion process of local recurrence and distant metastasis,and enhance the death rate.The detection of HGT components should be considered in the process of LACC diagnosis.

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Objective To test the reliability and validity of the Chinese Version of the Student Nurse Stress Index Scale ( SNSI-CHI ) among Chinese nursing students. Methods A random sampling method was used to collect 1100 nursing students who were from two medical universities of Henan Province, China,and SPSS 17. 0 and AMOS 17. 0 software were used. Results The average total score of SNSI-CHI was 58. 46±13. 90. The Cronbach's α was 0. 886,the test-retest intra-class correlation coefficient( ICC) of SNSI-CHI was 0. 996 (95％CI:0. 992-1. 000,P<0. 01). The item-to-total correlations ranged from 0. 351 to 0. 664 ( all P<0. 01) . The content validity index( CVI) was 0. 954. The result of exploratory factor analysis ( EFA) was that three factors together explained 75. 013％ of the total variances,and the confirmatory factory analysis( CFA) also indicated a good fit (χ2/df=1. 347,GFI=0. 956,AGFI=0. 945,RMR=0. 032,RMSEA= 0. 025, NFI=0. 974, IFI=0. 993, TLI=0. 992, CFI=0. 993 ) . Criterion-related validity was between 0. 330 and 0. 903 ( all P<0. 01) . Conclusion The SNSI-CHI is proved to be reliable and valid in China, and it can be used to measure the stress of Chinese nursing students.

Background Pterygium is one of the common ocular surface disorders,and the main drugs for pterygium include dexamethasone (DXM),interferon α-2b (IFN-α2b),mitomycin C (MMC),5-fluorouracil (5-FU),cyclosporin A (CsA) and tacrolimus (FKS06).However,the efficacy of these drugs on the fibroblasts from recurrence pterygium is unelucidated.Objective This study was to compare the efficacy of DXM,IFN-o2b,MMC,5-FU,CsA and FK506 on proliferation and apoptosis of recurrent pterygium-derived fibroblasts in vitro.Methods The specimens of recurrence pterygium were collected during surgery in Tianjin Medical University Ophthalmological Hospital from May 2015 to July 2016 under the written informed consent.Fibroblasts were isolated and cultured by explant culture method and identified by immunochemistry.DXM,IFN-α2b,MMC,5-FU,CsA and FK506 were added into the medium for 48 hours,respectively,and the cells cultured without drug were used as the control group.The inhibitory efficiency of different concentrations of DXM,IFN-α2b,MMC,5-FU,CsA and FK506 on the cell proliferation was assayed by cell counting kit-8 (CCK-8),and 50％ inhibiting concentration (IC50) of the drugs was calculated.The cells were treated by the IC50 dose of drugs for 48 hours,and cell apoptotic proportion and cell cycle were assessed by flow cytometry analysis.The expression of proliferating cell nuclear antigen (PCNA) in the cells after treated by drugs was detected by immunochemistry.Results Cultured cells grew well with the fusiform shape and radial arrangement.Vimentine showed the positive expression and keratin was absently expressed in the cells.The IC50 to the cells was (3.5×103±2.83×10-2)mg/L,(6.1×102±3.6×10-3)mg/L,(3.2×10-1±1×10-4)mg/L,(2.2× 101 ± 1.2× 10-3) mg/L,(6.3 × 101 ±2.5 × 10-3) mg/L and (6.0× 101 ± 0.0× 100) mg/L in the DXM,IFN-α2b,MMC,5-FU,CsA and FK506,respectively.In the 48 hours after treated by the IC50 drugs,the apoptotic ratio was (35.00± 3.21)％,(30.37±1.67)％,(26.11±0.75)％,(22.01±0.07)％,(20.95±1.68)％ and (19.85±0.52)％ in the IFN-α2b group,CsA group,MMC group,FK506 group,DXM group and 5-FU group,which was significantly higher than (11.38±2.18) ％ in the control group (all at P＜0.05).The cell proportion of G0/G1 phase,S phase and G2/M phase was (85.64±2.62)％,(5.29±1.56)％ and (2.73-±2.66)％ in the control group,and the cell proportion of G0/G1 phase was reduced,while that of S phase or G2/M phase was considerably increased in various drug groups (all at P＜0.05),with the blocking efficiency of cell cycle was in turn MMC,CsA,5-FU,DXM,IFN-α2b and FK506.The expressional rate of PCNA in the cells was (95.00 ± 2.00) ％,(82.67 ± 5.04) ％,(80.00 ± 2.78) ％,(64.00± 6.55)％,(38.00±3.00)％,(32.00±4.36)％ and (29.67±3.02)％ in the control group,FK506 group,DXM group,5-FU group,IFN-α2b group,CsA group and MMC group,showing a significant difference among the groups (F=25.995,P＜0.01),and the expressional rate of PCNA was significant lower in various drug groups than that in the control group (all at P＜0.05).Conclusions DXM,IFN-α2b,MMC,5-FU,CsA and FK506 are all able to inhibit the proliferation and promote the apoptosis of recurrent pterygium-derived fibroblasts in vitro,and MMC and CsA appear to have a stronger effect.

Objective To understand the status of stroke patients' perceived control and healthrelated quality of life,and to analyze the effect of perceived control on stroke patients' depression and health-related quality of life.Methods By convenience sampling,264 stroke patients were chosen to complete the questionnaire survey,Perceived Control Questionnaire,Hamilton Depression Scale and ShortForm Health Survey Scale-2.Results The score of patient's perceived control and health-related quality of life were (18.21±2.74),(46.62±11.56) points respectively.The perceived control had a negative correlation with the depression (r=-0.32,P ＜ 0.05),had a weak positive correlation with the body health (r=0.05,P ＜0.05),and had a positive correlation with the mental health of health-related quality of life (r=0.29,P ＜0.05),depression was negatively correlated with health-related quality of life of the body health,mental health (r=-0.26,-0.28,P ＜ 0.05).Conclusions Medical personal should improve the level of stroke patients' perceived control through various methods,to reduce depression and improve health related quality of life.