Objective To explore the impact of the three-level assistance model based on the narrative nursing theory on the mental health status of medical staff.Methods 140 medical staff working in a third class hospital in Xiangyang City were selected as the research object.The three-level assistance model based on narrative nursing theory was used to intervene them from September 2021 to July 2022.The symptom self-assessment scales before and after the intervention were compared.Results Before the intervention,the total score of SCL-90(156.37±32.56)points and the scores of various symptom factors of medical staff were higher;After the intervention,the total score of SCL-90(133.35±43.48)points and the scores of various symptom factors were lower than those before the intervention and the difference was statistically significant(P<0.05).Conclusion The three-level assistance model based on narrative nursing theory can reduce the total score of SCL-90 and the scores of various symptom factors,improve the mental health status and mental health level.

Objective To investigate the diagnostic value of detachable string magnetically controlled capsule endoscopy(ds-MCE)in patients with liver cirrhosis.Methods Patients with liver cirrhosis were screened for esophagogastroduodenoscopy(EGD)and ds-MCE examination to assess the accuracy of ds-MCE in identifying gastroesophageal varices,high-risk esophageal varices and portal hypertensive gastropathy using EGD as the gold standard,and evaluate the detection of portal hypertensive enteropathy and the comfort level of patients.Results From May 2021 to July 2022,a total of 53 patients with liver cirrhosis were successfully enrolled.With EGD as the gold standard,ds-MCE detected esophageal varices with 95.45％for sensitivity,100％for specificity and adjusted positive predictive value(PPV),95.65％for adjusted negative predictive value(NPV),and 0.877 for Kappa value(P＜0.001).For detection of gastric varices,ds-MCE had sensitivity,specificity,adjusted PPV,and adjusted NPV of 93.94％,90％,90.38％and 93.69％,and Kappa value of 0.839(P＜0.001).For detection of portal hypertension gastropathy,ds-MCE had sensitivity,specificity,adjusted PPV and adjusted NPV of 80％,90.70％,89.59％and 81.93％,and Kappa value of 0.657(P＜0.001).In differentiating high-risk esophageal varices,the sensitivity,specificity,adjusted PPV,and adjusted NPV were 76％,100％,100％and 77.43％,respectively;Kappa value was 0.770(P＜0.001).Of the patients with liver cirrhosis,26.0％(13/50)were diagnosed with portal hypertensive enteropathy.The main mucosal changes were edema,erythema,and vascular dysplasia.The ds-MCE comfort score of 3(2,4)was higher than that of the traditional EGD 1(0,3)(P＜0.000 1).Conclusion Compared with EGD,ds-MCE is an accurate,safe,feasible and comfortable method for detecting esophagogastric varices and portal hypertensive gastropathy in patients with liver cirrhosis.It is a potential alternative to EGD screening surveillance of gastroesophageal varices in patients with liver cirrhosis.

Objective To explore the effect of ephedrine on airway remodeling and its regulation effect on transfor-ming growth factor-β1(TGF-β1)/Smads pathway in asthmatic mice.Methods All mice were randomly separated into control group,model group,dexamethasone group,ephedrine low-dose group,ephedrine high-dose group,and ephedrine high-dose+TGF-β1 activator group,with 12 mice in each group.Except for the control group,mice in other groups were intraperitoneally injected with 40 μg ovalbumin(OVA)and 2 mg 10％aluminium hydroxide sensitizer to induce asthma models.After 8 weeks,the airway hyperresponsiveness of mice in each group was detec-ted;eosinophils in bronchoalveolar lavage fluid(BALF)were counted;ELISA was applied to detect the levels of interleukin(IL)-4,IL-5,and IL-13 in BALF;hematoxylin-eosin(HE)staining and Masson staining were applied to observe the pathological changes and collagen fiber area of mouse lung tissue;immunohistochemistry was applied to detect the expression of α-smooth muscle actin(α-SMA)protein in mouse lung tissue;Western blot was applied to detect the expression of TGF-β1/Smads pathway related proteins in mouse lung tissue.Results Compared with the control group,the airway hyperreactivity at different doses of methacholine,total area of airway wall(Wat)/perimeter of the basement membrane(Pbm)ratio,collagen fiber area,eosinophil,the contents of IL-4,IL-5,IL-13,the expression of α-SMA,TGF-β1,the ratios of p-Smad2/Smad2 and p-Smad3/Smad3 in the model group in-creased(P＜0.05),the expression of Smad7 decreased(P＜0.05);compared with the model group,the airway hyperreactivity at different doses of methacholine,Wat/Pbm ratio,collagen fiber area,eosinophil,the contents of IL-4,IL-5,IL-13,the expression of α-SMA,TGF-β1,the ratios of p-Smad2/Smad2 and p-Smad3/Smad3 in the dexamethasone group,the ephedrine low-dose and high-dose groups decreased(P＜0.05),the expression of Smad7 increased(P＜0.05);compared with the ephedrine high-dose group,the airway hyperreactivity at different doses of methacholine,Wat/Pbm ratio,collagen fiber area,eosinophil,the contents of IL-4,IL-5,IL-13,the ex-pression of α-SMA,TGF-β1,the ratios of p-Smad2/Smad2 and p-Smad3/Smad3 in the ephedrine high-dose+TGF-β1 activator group increased(P＜0.05),the expression of Smad7 decreased(P＜0.05).Conclusion E-phedrine can improve airway remodeling in asthmatic mice,and its mechanism is related to the regulation of TGF-β1/Smads signaling pathway.

Objective To investigate the effect and mechanism of Zhike Pingchuan Formula on reducing airway inflammation in mice with bronchial asthma(BA).Methods A total of 84 BALB/c mice were randomly separated into the control group,the BA group,the low-dose Zhike Pingchuan Formula group,the high-dose Zhike Pingchuan Formula group,the dexamethasone group,the lipopolysaccharide(LPS)group and the high-dose Zhike Pingchuan Formula+LPS group,with 12 mice in each group.The BA model was constructed in all groups of mice except the control group.After successful modeling,mice were treated with drug administration once a day for 3 weeks.Serum immunoglobulin E(IgE)concentration and levels of interleukin-17(IL-17)and tumor necrosis factor-α(TNF-α)in alveolar lavage fluid were detected by enzyme linked immunosorbent assay(ELISA).Pathological changes in lung tissue was detected by HE staining.The bronchial epithelium goblet cell proliferation and mucus secretion were determined by PAS staining.Flow cytometry was used to detect levels of T helper cell 17(Th17)and regulatory T(Treg)cell in mouse spleen tissue.Western blot assay was used to detect toll-like receptor 4(TLR4)/tumor necrosis factor receptor-associated factor 6(TRAF6)/nuclear factor kappa-B(NF-κB)pathway-related protein expression in lung tissue.Results Compared with the control group,damage of lung tissue was serious,the proliferation of bronchial epithelial goblet cells and the secretion of mucus increased,IgE concentration,TNF-α,IL-17 levels,Th17 cell proportion,Th17/Treg ratio,and TLR4,TRAF6,p-NF-κB p65 protein expression increased,while Treg cell proportion decreased in the BA group(P＜0.05).Compared with the BA group,the bronchial epithelial cupular cell proliferation and mucus secretion were reduced in the low-dose Zhike Pingchuan Formula group,the high-dose Zhike Pingchuan Formula group and the dexamethasone group,the lung tissue damage was improved,the concentration of IgE,levels of TNF-α,IL-17,the proportion of Th17 cells,the ratio of Th17/Treg and expression of protein levels of TLR4,TRAF6 and p-NF-κB p65 were reduced,and the proportion of Treg cell was elevated(P＜0.05).The trend of corresponding indexes in the LPS group was opposite to the above(P＜0.05).Compared with the high-dose Zhike Pingchuan Formula group,the pathological damage of lung tissue increased in the high-dose Zhike Pingchuan Formula+LPS group.The proliferation of bronchial epithelial goblet cells and the secretion of mucus increased,the IgE concentration,TNF-α,IL-17 levels,Th17 cell proportion,Th17/Treg ratio and TLR4,TRAF6,p-NF-κB p65 protein expression increased,while the Treg cell proportion decreased(P＜0.05).Conclusion Zhike Pingchuan Formula may reduce airway inflammation in BA mice by inhibiting TLR4/TRAF6/NF-κB pathway.

【Objective】 To evaluate the clinical value of capsule endoscope in the diagnosis of unexplained abdominal pain. 【Methods】 We made a retrospective analysis of 191 patients with unexplained abdominal pain who sought medical help in our hospital and 25 normal controls. Capsule endoscopy was performed in both groups, small bowel lesions were detected, and clinical data were collected for further analysis. 【Results】 The total small bowel lesion detection rate was 52.87% (101/191) in abdominal pain (AP) patients and 20% (5/25) in the control group, respectively. The detection rate of significant findings (ulcers, erosions, polyps, diverticula, parasites, and neoplastic organisms) was only 16.23% (31/191) in AP patients. In the non-significant findings, no statistical difference in the detection rates for vascular malformation, capillary dilation, and lymphoid follicular hyperplasia were found between the two groups, while the detection rate of intestinal lymphangiectasia was significantly higher in the AP patients (23.56% vs. 4%, P<0.05, OR=7.089). 【Conclusion】 Capsule endoscopy can be an optional choice for diagnosis of unexplained abdominal pain, while the relationship between positive findings and abdominal pain should be further investigated.

Objective To investigate the prevalence of hepatitis D virus (HDV) infection among patients with chronic hepatitis B virus (HBV) infection in some regions of China. Methods Serum samples were collected from 3 131 patients with chronic HBV infection in 10 provinces, cities, and autonomous regions of China from March 2021 to June 2022, and anti-HDV IgG ELISA was used for the detection of all serum samples. Nested reverse transcription-polymerase chain reaction (nRT-PCR) was used to detect HDV RNA in anti-HDV IgG-positive samples, and the nRT-PCR amplification products of HDV RNA-positive samples were sequenced and analyzed to determine HDV genotype. The clinical features of anti-HDV IgG-positive patients were analyzed. The Mann-Whitney U rank sum test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results The positive rate of anti-HDV IgG in the 3 131 patients with chronic HBV infection was 0.70% (22/3 131), and that in the patients with chronic HBV infection in Inner Mongolia Autonomous Region, Xinjiang Uygur Autonomous Region, Beijing, and Hunan Province was 1.81% (16/886), 0.88% (2/226), 0.28% (2/708), and 1.00% (2/200), respectively; the patients with chronic HBV infection in Inner Mongolia Autonomous Region had a significantly higher positive rate of anti-HDV IgG than those in Beijing ( P =0.004), and there was no significant difference between the other regions ( P > 0.05). Clinical features of the patients with chronic HBV infection in Inner Mongolia Autonomous Region showed that compared with the anti-HDV IgG-negative group, the anti-HDV IgG-positive group had a significantly higher proportion of patients with Mongol nationality ( P =0.001), abnormal alanine aminotransferase ( P =0.007), or antiviral treatment ( P =0.029), as well as a significantly lower median HBV DNA level ( P =0.030). A total of 19 HDV RNA-positive samples were identified, all of which had HDV genotype 1. Conclusion The prevalence rate of HDV varies greatly across different regions of China, with a higher prevalence rate of HDV in patients with chronic HBV infection from Inner Mongolia Autonomous Region. HDV genotype 1 is the predominant genotype in some provinces and cities of northern China.

Objective:To explore the cause and treatment of chylothorax after surgery for congenital heart disease(CHD) in newborns.Methods:A retrospective analysis was made to the clinical data of 49 newborns with chylothorax after surgery for CHD within the period from January 2009 to December 2019. These newborns were aged from from 1 day to 28 days with the weight from 2.0 kg to 4.1 kg. The complete transposition of great arteries was performed in 13 cases, coarctation of the aorta/ interruption of the aortic arch in 13 case, right ventricular outflow tract reconstruction/ Blalock-Taussing shunt in 9 cases, total anomalous pulmonary venous connection in 8 cases, ventricular septal defect repair and atrial septal defect repair in 4 cases, ligation of patent ductus arteriosus in 1 case and persisten truncus arteriosus in 1 case. Chylothorax occurred in the right in 19 cases, left side in 20 cases, bilateral in 9 cases and the pericardium in 1 case. The diagnosis was made at the time from 1 day to 22 days after the surgery with an average of 8 days.Results:43 patients were cured(87.75%), 41 cases(83.67%) were cured with diet and support therapy, the course lasted from 4 days to 65 days with an average of 11 days; 1 cases, because of the poor effect of diet and support therapy, was given pleural injection of high-sugar combined with octreotide treatment; 1 case received thoracic duct ligation as the conservative therapy was ineffective; 6 cases of death due to heart failure/ severe pulmonary hypertension after operation, and parents gave up.Conclusion:Individualization conservative therapy is the first choice for chylothorax, while timely surgery can raise the survival rate and save the hospitalization time and the cost.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

【Objective】 To study the diagnostic value of balloon expulsion test, anorectal manometry, and colonic transit test for detecting constipation with defecation disorders. 【Methods】 Outpatients with functional constipation were retrospectively analyzed and classified into dyssynergic defecation constipation and non-dyssynergic defecation constipation according to the Rome Ⅳ diagnostic criteria. We studied the differences in symptomatological characteristics and results of the three testing methods between the two groups of patients. 【Results】 Among the 48 patients with functional constipation included, there were 13 males (27.1%) and 35 females (72.9%) with an age of (44.8±12.3) years, including 32 patients (66.7%) with defecation disorder and 16 patients (33.3%) with non-defecation disorder. The percentage of anal distension was significantly higher in patients with dyssynergic defecation constipation than in those with non-dyssynergic defecation constipation (34.4% vs. 0.0%, P=0.021). All the three tests had diagnostic value for dyssynergic defecation constipation, but with low diagnostic agreement between the results of each test. The diagnostic sensitivity of anorectal manometry was 100%, but the specificity (56.3%) was low, and both the positive predictive value (82.1%) and the negative predictive value (100%) were higher; the diagnostic sensitivity (75.0%) and specificity (81.3%) of the balloon expulsion test were both higher. The Youden index of colonic transit test was the smallest. The anal resting pressure and maximum systolic pressure of dyssynergic defecation constipation were lower than those of non-dyssynergic defecation constipation (75.2 mmHg vs. 97.1 mmHg, 168.7 mmHg vs. 251.6 mmHg). The two types of constipation did not significantly differ in anorectal pressure gradients during simulated defecation or rectal sensory function. 【Conclusion】 The balloon expulsion test can be used as a primary screening test for constipation with defecation disorders, and anorectal manometry has the highest comprehensive diagnostic value, but there is a certain false positive rate, and the colonic transit test has the lowest diagnostic efficacy. Thus a comprehensive analysis of the patient’s symptoms and the results of different tests is needed in clinical practice.

Objective:To investigate the body composition and sarcopenia in patients with stable chronic obstructive pulmonary disease (COPD) and to analyze the influencing factors.Methods:A total of 220 patients with stable COPD were enrolled in the study from China-Japan Friendship Hospital during July 2018 to December 2019; 220 age and sex-matched healthy subjects (control group 1) and 220 healthy young adults aged 20-40 years (control group 2) were enrolled from the community. The body composition was measured by bioelectrical impedance method. The demographic characteristics, disease conditions, living background and other related factors were collected by questionnaire. T test or one-way ANOVA were used for comparison between groups, and non parametric test was used for non normal distribution data.Results:Compared with the control group 1 and control group 2, the body fat rate ( Z=-10.037, t=-8.411), the fat free mass index ( Z=-8.165, t=-7.856), and appendicular skeletal muscle index (ASMI) ( t=-7.158, t=-11.989) were significantly lower in stable COPD patients ( P<0.05). Among 220 patients with stable COPD, 51 (23.2%) were diagnosed as sarcopenia; the prevalence of sarcopenia was 18.3% (24/131) in men and 30.3% (27/89) in women (χ2=4.297, P=0.038). The decreased ASMI and grip strength in COPD patients with sarcopenia were significantly associated with age≥75 (χ2= 15.746, F= 14.048), female sex ( Z=5.805, t=2.672), low income ( Z=-4.291, t=-4.789), Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade Ⅳ (χ2=22.644, F=3.905), Modified British Medical Research Council (mMRC) Dyspnea Scale grade 4 (χ2=12.475, F=4.369), not receiving systematic health education ( Z=-4.239, Z=-2.474), no exercise (χ2=14.786, F=3.402), insufficient nutrition intake (χ2=40.531, F=10.529). The range of 6-min walking distance was (110-268) m, that was even shorter for patients with mMRC dyspnea scale grade 4 ( F=3.468, P<0.05). Conclusion:The impairment of body composition is common in COPD patients, which will further affect the body function. It is suggested that the routine evaluation of COPD should include the measurement of body composition.