Objective:To explore a simplified and efficient early prediction model for severe acute pancreatitis (SAP) using the least absolute shrinkage and selection operator (LASSO) regression, and to construct both logistic regression and decision tree models. The aim is to identify high-risk individuals, guide clinical treatment, and improve patient outcomes.Methods:A retrospective analysis was conducted on the clinical data of 412 patients with acute pancreatitis admitted to the Emergency and Gastroenterology Departments of the First Affiliated Hospital of Anhui Medical University and its High-tech Branch from November 2020 to September 2023. LASSO regression was employed to identify factors significantly associated with SAP, followed by the construction of a multivariate logistic regression model and a decision tree model. The predictive performance of these models was evaluated and compared to the bedside index for severity in acute pancreatitis (BISAP).Results:Among the 412 patients, the incidence of SAP was 12.14% ( n=50). Seven variables significantly associated with SAP severity were identified by LASSO regression, including respiratory rate at admission, pain score at admission, pleural effusion, fibrin degradation products, C-reactive protein, serum creatinine, and serum albumin. The logistic regression model incorporated four variables: pleural effusion, pain score at admission, serum creatinine, and serum albumin. In the training set, the model demonstrated a sensitivity of 0.528, specificity of 0.984, accuracy (95% CI) of 0.928 (0.892-0.955), Kappa value of 0.606, and AUC (95% CI) of 0.920 (0.862-0.979). In the testing set, the model showed a sensitivity of 0.643, specificity of 0.925, accuracy (95% CI) of 0.891 (0.822-0.941), Kappa value of 0.519, and AUC (95% CI) of 0.923 (0.861-0.985). The decision tree model comprised three branches and four terminal nodes, indicating that serum creatinine, serum albumin, and pleural effusion could effectively predict SAP occurrence. In the training set, the decision tree model had a sensitivity of 0.500, specificity of 0.973, accuracy (95% CI) of 0.914 (0.876-0.944), Kappa value of 0.544, and AUC (95% CI) of 0.812 (0.731-0.894). In the testing set, the model exhibited a sensitivity of 0.500, specificity of 0.925, accuracy (95% CI) of 0.875 (0.802-0.928), Kappa value of 0.412, and AUC (95% CI) of 0.709 (0.565-0.853). The DeLong test revealed that in the training set, the AUC of the logistic regression model was significantly greater than that of the decision tree model ( P<0.01) and the BISAP score ( P<0.001), while the AUC difference between the decision tree model and the BISAP score was not statistically significant ( P=0.762). In the testing set, the AUC of the logistic regression model was again greater than that of the decision tree model ( P<0.01) and the BISAP score ( P=0.018), whereas the AUC of the decision tree model was lower than that of the BISAP score ( P=0.017). Conclusions:Both the logistic regression and decision tree models demonstrate good predictive value for SAP, and their combined use may provide valuable guidance for clinical practice.

Objective To establish a model of combined injury of thermal radiation and blast wave of gas explosion in closed pipeline,and investigate the characteristics of important organ injury induced by burn-blast combined injury in rats.Methods A total of 72 male SD rats(aged 8～10 weeks,weighing 200～10 g)were randomly divided into control group and mild and severe injured groups.After the model rats were inflicted with blast wave and thermal radiation,their physical parameters were detected and measured.The respiratory function of the survival rats was tested.In 24 h later,arterial blood gas analysis,blood biochemical tests,and detection for serum inflammatory factors and lung injury related protein levels were performed,and the pathological changes in the lung tissue and trachea were observed.Results The peak range of explosive blast wave overpressure was 209～493 kPa,and the temperature was 152～258 ℃.The mortality rate was 8.3％in the mild group and 53.1％in the severe group.Compared with the control group,longer inspiratory time(Ti)and relaxation time(Tr)and larger tidal volume(TV)(P＜0.05),while lower respiratory frequency(f)were observed in the 2 injured groups within 6 h after injury(P＜0.05).At 24 h after injury,the values of partial pressure of carbon dioxide(PaCO2),residual base value(BE)and bicarbonate(HCO3-)were increased significantly(P＜0.05),while partial pressure of oxygen(PaO2)was decreased(P＜0.05).The serum levels of alanine transaminase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),total bilirubin(TBI)and total bile acid(TBA)were notably elevated(P＜0.05).So were the levels of IL-1 β,TNF-α and IL-6(P＜0.01).Various severities of hyperemia foci and inflammation in the tracheal mucosa were observed in the injured rats.The incidence of lung injury was high,and the pathological manifestations were dot-shaped hemorrhage to diffuse hemorrhage of the whole lobe,rupture of alveolar septum,thickening of septum,and infiltration of red blood cells and inflammatory cells.The levels of serum lung injury-related proteins were significantly increased(P＜0.05).Conclusion A rat model which can highly simulate mild to severe burn-blast combined injury is constructed,which can meet the needs for rat model in study of explosive burn-blast compound injury.The main characteristics of the injury are lung injury,respiratory dysfunction,liver damage and secondary infection.

Objective:To investigate the fundus fluorescein angiography (FFA) characteristics of spontaneous regression in retinopathy of prematurity (ROP) and the range of retinal vascularization.Methods:A clinical retrospective study. A total of 82 eyes of 41 infants with ROP, who underwent FFA from January 2019 to December 2021 in Department of Ophthalmology of Xijing Hospital after completion of ROP regression, were included. There were 25 males (50 eyes) and 16 females (32 eyes). ROP was diagnosed in Zone Ⅱ in 44 eyes, with 38 eyes in stage 2 and 6 eyes in stage 3, and in zone Ⅲ in 38 eyes of stage 2. All patients underwent FFA examination under general anesthesia, at postmenstrual age of 70.70±12.25 weeks, after the natural regression of ROP was completed. Focus on the retinal vascular development, as well as choroid circulation and macular abnormalities, and compare and observe the differences between zone Ⅱ and Ⅲ after spontaneous regression. The extent of retinal vascularization was determined by the ratio between the distance of the center of the disc to the border of the vascularized zone (DB) and the center of the disc to the fovea distance (DF). The width of avascular area, recorded as the distance from the ora serrata to the vascular termination, was counted by disc diameters (DD). The measurement data between zone Ⅱ and zone Ⅲ ROP were compared by the independent sample t-test, and the count data were compared by χ2 test or Fisher exact probability test. Results:The linear choroidal pattern was present in 9 eyes (21.95%, 9/41), and the tortuous arteries in the posterior retina were detected in 32 eyes (39.02%, 32/82). It was noted that increased branching of vessels presented in 45 eyes (54.88%, 45/82), straight shape of vessels shown in 27 eyes (32.93%, 27/82), circumferential vessels arisen in 45 eyes (54.88%, 45/82), arteriovenous shunt appeared in 18 eyes (21.95%, 18/82), and capillary bed lost in 46 eyes (56.10%, 46/82) in areas from initial ridge to vascular termini. Punctate or linear dye leakage was observed in 23 eyes (28.05%, 23/82) during the late phase of FFA. Macular abnormalities, such as the absence of foveal avascular zone and hypoperfusion, were observed in 28 eyes (34.15%, 28/82), of which the macular ectopia presented in 1 eye. The mean DB/DF ratio of all the 82 eyes on the temporal side was 4.63±0.29 and 3.77±0.23 in the nasal. The mean avascular area on the temporal retina was 1.74±1.00 DD. Compared with ROP in zone Ⅲ, increased branching of vessels and dye leakage were more common ( χ2=9.303, 10.774; P=0.002, 0.001), the extent of temporal retinal vascularization was smaller ( t=-2.285, P=0.026), and the avascular area of the retina was more significant ( t=5.491, P<0.001) in zone Ⅱ ROP. Conclusions:Even after completion of spontaneous regression in ROP, incomplete retinal vascularization and vascular abnormalities may exist permanently in FFA, including those such as the tortuous arteries in the posterior retina, increased branching and straight shape of vessels, circumferential vessels, capillary bed lost and macular abnormality. Further appropriate follow-up is needed for long-term safety.

【Objective】 To investigate the effect and prognosis of Roxastat combined with levocarnitine and polysaccharide iron complex in patients with chronic renal failure hemodialysis anemia(CRFHA). 【Methods】 A total of 70 patients with CRFHA treated in our hospital from January 2019 to December 2020 were selected as study subjects. They were divided into control group and treatment group by simple randomizaiton grouping method. After 5 cases in each group dropped out due to transfer, COVID-19 epidemic and missed follow-up, 30 cases were left in each group.The control group was treated with Roxastat, and the treatment group with L-carnitine and polysaccharide iron complex based on Roxastat. The differences in anemia parameters, iron metabolism, dialysis-related indexes and complications between the two groups were observed and compared. 【Results】 After 3 months of treatment, Hb, RBC, Hct, TIBC, FE, and FERR in the treatment group were significantly higher than those in the control group (118.36±6.64 vs 109.34±6.25, 4.32±0.264 vs 4.03±0.32, 32.37±3.30 vs 29.85±3.24, 67.62±10.66 vs 62.78±10.32, 17.87±3.81 vs 12.51±3.82, 389.37±18.30 vs 362.85±18.04, respectively, P<0.05). No significant difference in dialysis-related indicators (serum creatinine, blood phosphorus, and blood calcium) between the two groups before and after 3 months of treatment was noticed (P>0.05). Blood creatinine of patients after 3 months of treatment was significantly higher (control group: 1 016.27±122.14 vs 1 052.27±96.23; observation group 1 014.23±121.57 vs 1 056.25±96.82, P<0.05); blood phosphorus (control group: 2.21±0.21vs 2.14±0.21; observation group: 2.23±0.30 vs 2.15±0.64) was significantly lower(P<0.05); blood calcium (control group: 2.07±0.51 vs 1.85±0.54; observation group 2.05±0.50 vs 1.87±0.52) was significantly lower (P<0.05 ). A comparison of complications between the two groups of patients after 6 months of treatment showed that the combined incidence of gastrointestinal function, increased blood pressure, and fever in the treatment group was lower than that in the control group, and the difference was statistically significant (P<0.05). 【Conclusion】 Roxastat combined with L-carnitine and polysaccharide iron complex in patients with CRFHA has definite effect, which improves dialysis-related indicators, has great advantages in optimizing anemia parameters and iron metabolism, and provides reference value for clinical treatment of CRFHA

Objective:To explore the effect of sub-inhibitory concentration of imipenem on the bio-activities of methicillin resistant Staphylococcus aureus(MRSA) and illuminate the inhibitory effects of carbapenem antibioty on the activity of MRSA and their mechanisms,and to provide the basis for using the carbapenem antibiotics in the treatment of MRSA infection.Methods:Five ST239 type of MRSA clinical isolates were selected and were co-cultured with 1/10 and 1/2 minimal inhibitory concentration (MIC) of imipenem for 1.5,6.0 and 12.0 h,which were divided into control group(no imipenem),1/10MIC group(1/10MIC of imipenem),and 1/2MIC group(1/2MIC of imipenem).Fluorescent quantitative real-time PCR method was used to determine the relative mRNA expression levels of virulence-related genes fibronectin A(fnbA),staphylococcal protein A(spa),α-hemolysin(Hla),leukocidin D(lek-D),leukocidin E(lek-E),and enterotoxin A in various groups;Spectrophotometry was used to detect the proliferation activity of MRSA strains in various groups in vitro.Results:After co-culture for 6.0 and 12.0 h,the proliferation activities of 5 trains of MRSA in 1/2MIC group in vitro were significantly decreased compared with control group (P<0.01).The relative mRNA expression levels of 6 virulence-related genes of 5 strains of MRSA in 1/10MIC and 1/2MIC groups were significantly decreased compared with control group(P<0.01).After co-culture for 12.0 h,the mRNA expressions of all the tested virulence-related genes were not found.Conclusion:The sub-inhibitory concentration of imipenem shows obviously inhibitory effect on the mRNA expressions of multiple virulence-related genes of ST 239 type of MRSA strains,and higher concentration of imipenem can suppress the proliferation of MRSA strains in vitro.Imipenem shows the potential value in the treatment of the severe MRSA infected patients.

Objective To explore the application effects of free body position with delivery vehicles in the first late stage of labor and the second stage of labor, and to choose a proper delivery position for parturient women.Methods Totally 208 primiparas who had term and spontaneous labor in single pregnancy and head position between August and September 2015 in a maternal and child health hospital were selected and allowed to get out of bed at their will in the first late stage of labor and the second stage of labor. Midwives accompanied and instructed parturient women to use free body position with delivery vehicles, and when head visible on vulval gapping for 2 cm×2 cm, assisted the parturient women for conventional delivery on delivery beds. And 175 primiparas awaiting delivery using traditional horizontal position and fowler position between August and September 2014 were selected as a control group. Then their time of the second stage of labor, intrapartum hemorrhage, perineal laceration or episiotomy, forceps delivery, Apgar scores and body weight of neonates were compared.Results There was no statistical difference in the second stage of labor, intrapartum hemorrhage, perineal episiotomy and forceps delivery between the parturient women using free body position with delivery vehicles and those using traditional horizontal position and fowler position in the first late stage of labor and the second early stage of labor (P>0.05). With the use of free body position with delivery vehicles, the parturient women's VAS was decreased from (8.11±1.59) to (6.49±1.90) (t=13.16,P<0.001).Conclusions Based on the evaluation of engagement, the use of free body position with delivery vehicles in the first late stage of labor until their delivery on bed in the second stage of labor is safe for parturient women and helps to reduce their delivery pain substantially.

Objective To investigate the self-management behaviors in patients with liver cirrhosis and analyze its influencing factors. Methods Totally 103 liver cirrhosis patients were recruited by convenience sampling method. They were investigated by using Self- management Questionnaire for Chinese patients with liver cirrhosis. Results The total score of self-management behaviors was 63.69 ± 13.60. All subscales scoring from high to low in turn were medication, diet management, condition monitoring and daily management. Conclusions The self-management level in patients with liver cirrhosis of decompensation period need to be improved, nursing staff should pay attention to effect evaluation during the hospital health education, to ensure that patients can master disease self-management knowledge, to improve the self-management behavior of patients with liver cirrhosis.

OBJECTIVE:To study the cardiac and skeletal toxicity of retinoic acid (RA) in Danio rerio at early life stage. METHODS:Danio rerio embryos of 24 hours post fertilization(hpf)were used as toxicity model and were exposed under medium with various concentrations of RA(0.1,1,10,25,100 μmol/L). The morphology of embryos and larvae hearts were observed 24,48 h after exposed. LC50 was calculated. Danio rerio larvae of 4 days post fertilization (dpf) were used as skeletal deformity model and were exposed with a series of RA at various concentration(0.1,1,10,25,50μmol/L). They were sacrificed 5 d later, and then Danio rerio skeleton were fixed for staining with alizarin red. The microscopic was used to observe the difference of stained skeleton area. RESULTS:RA caused significant adverse effects on hatching capabilities of Danio rerio embryos,and the ob-vious malformation features were produced during the culture process. 1-100 μmol/L RA could cause heart malformation in Danio rerio embryos and larvae,and the main heart malformation characteristics included heart linearization,pericardial edema,yolksa-cedema,hemocytes accumulation incardiac region. 100 μmol/L RA could inhibit the hatching capabilities of Danio rerio embryos, and caused lethal effects on embryos and larvae. The LC50 were 36.44,23.69 μmol/L after exposed for 24,48 h. 0.1-50 μmol/L RA induced vertebral column sclerotization of Danio rerio embryos and larvae in advance,which was positively associated with the con-centration of RA. CONCLUSIONS:RA can cause cardiac and skeletal toxicity in Danio rerio embryo and larvae,which is positive-ly associated with the concentration of RA.

Objective To study the effects of neonatal bilateral and unilateral early sucking on the secretion time and the amount of colostrum.Methods A total of 300 cases with normal full-term delivery and nipple condition were selected and randomly divided into two groups:bilateral early sucking group and unilateral early sucking group.Women in the two groups were assisted by a midwife within 1 h after birth to implement early suction,with women of bilateral early sucking receiving breast sucking 15 minutes on each side and unilateral early sucking group 30 minutes just on one side.Maternal lactation′s initiating time and amount of lactation of two groups after postpartum 6 hours,24 hours,48 hours and 72 hours were analyzed.Results There was no difference of lactation initiating time in bilateral early sucking group and unilateral early sucking group (P >0.05).After 6 hours,lactation in the 2 groups had no difference (P >0.05).After 24 hours,48 hours and 72 hours,number of women with sufficient lactation in bilateral early sucking group was greater than unilateral early sucking group (P <0.05).Conclusions Bilateral early sucking is more favorable than unilateral early sucking postpartum for lactation amount.

Objective To study the correlation between thyroid autoantibodies anti‐thyroid peroxidase antibody (TPOAb) with recurrent miscarriage to seek the objective data indicator for clinical diagnosis of recurrent miscarriage .Methods A total of 1 016 pregnant women of physical examination and normal thyroid function in the obstetric and gynecologic clinic of our hospital from March 2012 to May 2014 were selected as the research subjects .Among them ,90 cases of abortion were screened out and di‐vided into the primary abortion group(60 cases) and the recurrent abortion group(30 cases) .90 healthy childbearing age women of physical examination were selected as the control group .The positive TPOAb cases were performed statistics and compared among various groups ,the ratio was calculated;the TPOAb level was recorded in each group .At the same time the correlation between TPOAb with recurrent abortion was analyzed .Results The TPOAb positive rate in the recurrent abortion group was 46 .67% , which was significantly higher than 25 .00% in the primary abortion group and 4 .44% in the control group;at the same time the TPOAb positive rate of primary abortion group was also significantly higher than that of the control group ,the difference had sta‐tistical significance (P<0 .05) .The TPOAb concentration level in the recurrent abortion group was significantly higher than that in the primary abortion group and the control group;the TPOAb concentration level in the primary abortion group was also signifi‐cantly higher than that in the control group ,the differences were statistically significant (P< 0 .05) .In the follow‐up of adverse pregnancy occurrence with recurrent abortion as the adverse pregnancy event ,and according to the method of Spearman correlation analysis ,with the increase of TPOAb level ,the occurrence rate of recurrent miscarriage was higher ,which showed the positive cor‐relation(r=0 .764 ,P=0 .000) .Conclusion Monitoring the patient′s TPOAb level can better show the symptoms of recurrent abor‐tion .