Objective:To construct a comprehensive and targeted risk assessment index system for central venous catheter (CVC) dysfunction in patients undergoing continuous renal replacement therapy (CRRT) .Methods:The risk assessment indicators for CVC dysfunction in CRRT patients were determined based on literature review and Delphi expert consultation. From July to September 2023, 19 experts in hemodialysis were selected for expert consultation. Based on expert opinions and screening criteria, corresponding indicators were added, deleted, or modified. After the second round of consultation, the expert opinions tended to be consistent.Results:A total of 17 experts completed two rounds of consultation. In the two rounds of consultation, the effective response rates of the questionnaires were 89.5% (17/19) and 100.0% (19/19), respectively, and the expert authority coefficients were 0.87 and 0.88, respectively. The Kendall harmony coefficients were 0.131 and 0.138 ( P<0.05). The final risk assessment index system included seven primary indicators and 44 secondary indicators. Conclusions:The risk assessment index system for CVC dysfunction in CRRT patients constructed is scientific, reliable, and practical, which can provide reference for clinical medical and nursing staff to improve catheter risk management in CRRT patients.

Objective:To clarify peripheral Th17 level in SSc patients and its correlation with disease.Methods:Chinese databases CNKI, CBM, Wanfang and VIP, and English databases PubMed, EMBASE, Web of Science, Cochrane Library and Science Direct were searched to collect a case-control study on the content of Th17 cells in peripheral blood of patients with SSc. The papers published when the database was first developed in 25 February 2021. Meta-analysis was conducted using Stata 12.0 software, and I2 and Egger tests were used to evaluate the heterogeneity and publication bias between studies. Results:A total of 26 case-controls were included in the study, including 1 160 patients with SSc and 778 healthy controls. Overall, the percentage of Th17 cells in SSc patients was higher than in healthy controls [SMD(95% CI)=1.85 (1.33, 2.38), P<0.001], which was most significant in IL-17 +Th17 concentration [SMD(95% CI)=1.88 (1.28, 2.48), P<0.001]. As for disease activity, the proportion of Th17 cells in active SSc patients was much higher than those of patients in remission [SMD(95% CI)=1.92 (1.12, 2.71), P<0.001]. SSc patients had a reduced Th17 level after receiving DMARDs treatment [SMD(95% CI)=-0.74 (-1.05, -0.42), P=0.029]. Conclusion:The number of Th17 cells increase significantly in the peripheral blood of patients with SSc, and is related to disease activity. DMARDs can be used to treat this disease by downregulating Th17 levels.

Objective To investigate the protective effect of dexamethasone on hearing loss induced by canalwall-down mastoidectomy.Methods A total of 76 patients (76 ears) were randomized to dexamethasone group and non dexamethasone group with 38 patients in each group.For dexamethasone group,gelfoam soaked with dexamethasone (5 mg/ml) was topically applied to the round window niche at the end of the surgery,and dexamethasone was administrated intravenously at the dosage of 5 mg/50 kg immediately after the surgery.While for non-dexamethasone group,dexamctbasone was not used.The pure-tone audiograms were performed before mastoidectomy and 90 days after the surgery.Absolute bearing change was defined as the difference in hearing thresholds in decibels before and after the surgery.Results The changes of bone conduction thresholds in dexamethasone group were 8.3± 3.9 dB at 6 kHz,11.3±5.2 dB at 8 kHz,and 10.1±7.2 dB for HPTA (4-6-8 kHz high tone average).As in non-dexamethasone group,the changes of bone conduction thresholds were 13.7±4.6 dB at 6 kHz,25.1±5.4 dB at 8 kHz,19.3±9.7 dB for HPTA.There were significant differences in the changes of bone conduction thresholds between dexamethasone and non dexamethasone groups at frequencies of 6 kHz (P=0.039),8 kHz (P=0.007) and HPTA (P=0.009).Conclusion The results demonstrated that application of dexamethasone significantly reduced sensorineural high frequencies (6 kHz and 8 kHz) hearing loss after canal-wall down mastoidectomy,thus the use of dexamethasone is recommended.

Objective To study the protective effects of salvia miltiorrhiza on acute acoustic trauma (AAT) showed by temporary threshold shifts (TTS) induced by impulse noise.Methods A total of 62 male soldiers from a boot camp were randomly divided into the experimental group and the control group,each with 31 persons.The experimental group was treated with salvia miltiorrhiza,and the control group with placebo.Salvia miltiorrhiza was taken orally at the dosage of 780 mg each time,three times a day for 3 consecutive days before the live fire training and 1 day after the live fire training.The pure tone thresholds of right ears of these two groups were measured and compared 72 hours before live fire training and 6 hours after the live fire training.Results The puretone averages at 0.5,1 and 2 kHz of the right ears of the experimental group and the control group before live fire training were 16.32±6.12 dB and 16.21±5.42 dB,respectively,and the averages at 4,6 and 8 kHz were 14.22±5.16 dB and 14.89±5.38 dB,respectively.There were no significant differences between the 2 groups(P＞0.05).The PTAs of the right ears of the experimental group and the control group 6 hours after live fire training were 21.88±5.71 dB and 21.66±6.62 dB,respectively(P＞0.05),while the HPTAs were 25.89 ± 7.97 dB and 39.75 ± 7.84 dB,respectively(P＜0.01).There were significant differences in TTS between the two groups at 4,6 and 8 kHz(P＜ 0.01).Conclusion Salvia miltiorrhiza can reduce TTS at high frequencies induced by AAT.It has a potential preventive effect on AAT.

Objective To observe the effect of hyperbaric oxygen (HBO) therapy combined with repeated transcranial magnetic stimulation (rTMS) on patients with cognitive dysfunction after cerebral infarction.Methods A total of 81 patients with cognitive dysfunction after cerebral infarction were randomly divided into a control group,an HBO group and a combined treatment group,each of 27.In addition to basic medication and traditional rehabilitation therapy,the HBO group was also treated with hyperbaric oxygen,while the combined treatment group received both HBO and rTMS.The mini-mental state examination (MMSE) and the Montreal cognitive assessment (MoCA) were administered before and after the four weeks of treatment.Results The average MMSE scores of the HBO and combined treatment groups were both significantly higher than that of the control group,with the former significantly higher than the latter.Moreover,the average MoCA score of the HBO group was also significantly higher than that of the combined treatment group,and both were significantly higher than that of the control group.Conclusion Hyperbaric oxygen therapy can more effectively improve the cognitive function of patients with cognitive dysfunction after the cerebral infarction when it is combined with repeated transcranial magnetic stimulation.

Objective To explore the therapeutic effect of drinking water test combined with swallowing training on cerebral infarction patients with dysphagia.Methods A total of 68 cerebral infarction patients with dysphagia in our department were randomly divided into observation group and control group.The control group was given routine nursing,while the observation group was given drinking water test to guide diet,and systemic swallowing function training on the basis of the control group.The therapeutic effects,feeding conditions and VSD scale scores were compared after 1 month of intervention between the two groups.Results The drinking water test score in the observation group was lower than that in the control group,and the total effective rate of the swallowing function improvement was higher than that in the control group,the differences were statistically significant (P ＜ 0.05).The FOIS score in the observation group was higher,and the score of VSD scale was lower than that in the control group,the differences were statistically significant (P ＜ 0.05).Conclusion Drinking water test combined with swallowing training can effectively improve the swallowing function of patients with dysphagia after cerebral infarction,and is beneficial to the normal diet of the patients.

Objective To study the effect of comprehensive nursing intervention on improving postoperative pain in middle-aged and elderly patients with proximal humerus fractures.Methods A total of 94 elderly patients underwent surgical treatment of proximal humerus fractures were divided into control group and experimental group according to the random number table method,with 47 cases per group.The control group was given routine fracture nursing intervention during perioperation,and the experimental group was given comprehensive nursing intervention on the basis of conventional nursing,all the patients were followed up for 6 months.The complications,the degree of pain and the recovery of shoulder function were observed and compared between the two groups.Results The total incidences of complication in postoperative bedsores,respiratory infections,fluctuations in blood pressure,inflamed fractures were lower than that in the control group (P ＜ 0.05);The VAS score of the experimental group was lower than that of the control group at 1 d,1 week and 1 month after nursing intervention (P ＜ 0.05).The Constant-Murley score of the experimental group was significantly higher than that of the control group at 3 months and 6 months after the intervention (P ＜ 0.05).Conclusion Comprehensive care intervention is effective for elderly patients with proximal humerus fractures in the perioperative period,and it can effectively reduce postoperative complications and degree of postoperative pain,promote patients'shoulder function recovery,so it is worthy of application and promotion.

Objective To explore the therapeutic effect of drinking water test combined with swallowing training on cerebral infarction patients with dysphagia.Methods A total of 68 cerebral infarction patients with dysphagia in our department were randomly divided into observation group and control group.The control group was given routine nursing,while the observation group was given drinking water test to guide diet,and systemic swallowing function training on the basis of the control group.The therapeutic effects,feeding conditions and VSD scale scores were compared after 1 month of intervention between the two groups.Results The drinking water test score in the observation group was lower than that in the control group,and the total effective rate of the swallowing function improvement was higher than that in the control group,the differences were statistically significant (P ＜ 0.05).The FOIS score in the observation group was higher,and the score of VSD scale was lower than that in the control group,the differences were statistically significant (P ＜ 0.05).Conclusion Drinking water test combined with swallowing training can effectively improve the swallowing function of patients with dysphagia after cerebral infarction,and is beneficial to the normal diet of the patients.

Objective To study the effect of comprehensive nursing intervention on improving postoperative pain in middle-aged and elderly patients with proximal humerus fractures.Methods A total of 94 elderly patients underwent surgical treatment of proximal humerus fractures were divided into control group and experimental group according to the random number table method,with 47 cases per group.The control group was given routine fracture nursing intervention during perioperation,and the experimental group was given comprehensive nursing intervention on the basis of conventional nursing,all the patients were followed up for 6 months.The complications,the degree of pain and the recovery of shoulder function were observed and compared between the two groups.Results The total incidences of complication in postoperative bedsores,respiratory infections,fluctuations in blood pressure,inflamed fractures were lower than that in the control group (P ＜ 0.05);The VAS score of the experimental group was lower than that of the control group at 1 d,1 week and 1 month after nursing intervention (P ＜ 0.05).The Constant-Murley score of the experimental group was significantly higher than that of the control group at 3 months and 6 months after the intervention (P ＜ 0.05).Conclusion Comprehensive care intervention is effective for elderly patients with proximal humerus fractures in the perioperative period,and it can effectively reduce postoperative complications and degree of postoperative pain,promote patients'shoulder function recovery,so it is worthy of application and promotion.

Objective To explore the relationship between MRI signal intensity in pallidum and levels of total bilirubin in neonatal hy-perbilirubinemia. Methods From July, 2014 to October, 2015, sixty neonates were divided into three groups according to the levels of total serum bilirubin (TSB), that were group I (TSB 17.1~34.2μmol/L, n=16), group II (TSB>34.2~340μmol/L, n=34), and group III (TSB>340μmol/L, n=10). They were screened with 3.0 T MRI, and the T1WI signal intensity of bilateral pallidum was measured. Results The bi-lateral signal intensity was higher in group III than in group II and group I. There was positive correlation between signal intensity and TSB levels. Conclusion The MRI signal intensity in pallidum may help for diagnosis of neonatal bilirubin encephalopathy.