Objective:To analyze and compare the association between different obesity-related indices and vitamin D deficiency in middle-aged and elderly population dwelled in Lanzhou city.Methods:From May, 2011 to September, 2012, middle-aged and elderly individuals with complete baseline data were included via randomly cluster sampling from 3 communities in Lanzhou. The subjects were divided into 4 subgroups by vitamin D levels and various obesity-related indices were compared across subgroups with the same gender. The relationship between the obesity-related indices and the severity of vitamin D deficiency was analyzed using Spearman correlation analysis, and the effects of different obesity-related indices on the severity of vitamin D deficiency was analyzed using multivariate logistic regression analysis.Results:A total of 9 437 residents were included. The overall prevalence of vitamin D deficiency was 97.7%. Compared with the group with lower vitamin D level, participants in the group with higher vitamin D level showed evidently lower body mass index (BMI), waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI) and triglyceride/ high density lipoprotein cholesterol (TG/HDL-C) ratio in the total population and females, while only WC, LAP, VAI and TG/HDL-C in the males (all P<0.05). Spearman correlation analysis showed that BMI, WC, LAP, VAI and TG/HDL-C were positively correlated with the severity of vitamin D deficiency in the total population and the females, while only LAP, VAI and TG/HDL-C in the males (all P<0.05) . Multivariate logistic regression analysis showed that higher levels of these obesity related indices were correlated with more severe vitamin D deficiency in the total population and the females, while only higher LAP, VAI and TG/HDL-C in the males (all P<0.05). The effects of higher LAP was the most prominant in the total population ,the females and the males. Conclusion:Various obesity phenotypes are closely related to vitamin D deficiency in middle-aged and elderly women, while only visceral obesity and abnormal lipid metabolism are related to vitamin D deficiency in middle-aged and elderly men, with LAP being the most important influencing factor.

Objective:To understand the genome sequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and spike protein variations during different epidemic periods in Wuxi City.Methods:Nucleic acid was extracted from the nasopharyngeal swab samples of six local cases of coronavirus disease 2019 (COVID-19) (from January to February, 2020) and 13 imported cases of COVID-19 (from March to September, 2021) in Wuxi City, and the whole genome was amplified to construct the sequencing library. The second-generation sequencer was used for sequencing. The CLC Genomics Workbench (21 version) software was used to analyze the offline data with NC_045512.2 as the reference strain, and MEGA 7.0 software was used to construct the phylogenetic tree.Identification of type was conducted by Nextstrain typing method and phylogenetic assignment of named global outbreak lineages (Pangolin) typing method.Results:There were five subtypes in Nextstrain and seven subtypes in Pangolin of the nineteen patients with COVID-19. Compared with NC_045512.2, the median nucleotide mutation sites were 29 (range 0 to 42) and amino acid mutation sites were 20 (range 0 to 34). The six local and 13 imported cases had no common nucleotide mutation sites and were in different evolutionary branches. The sequences of the six local cases were highly homologous with the reference strain sequences (NC_045512.2) at the early stage of the pandemic, and the evolutionary distance was close to that of the reference strain. The 13 imported cases were obviously divided into three evolutionary branches (Alpha, Beta, Delta variant).The four Beta variants shared eight amino acid mutation sites in spike protein, and the two Alpha variants shared eight amino acid mutation sites in spike protein, and the seven Delta variants shared five amino acid mutation sites in spike protein.Conclusions:New mutations of SARS-CoV-2 are constantly emerging during the epidemic. The increase of the nucleotide sites number may result in the change of spike protein amino acid. Therefore, the whole-genome sequencing analysis plays an important role in the accurate tracing of epidemic origin and adjustment of prevention and control measures.

Objective:To explore the prevalence and risk factors of thyroid nodules in physical examination population.Method:A total of 5934 Han people who underwent physical examination in the physical examination center of the Affiliated Hospital of Hubei University of Arts and Sciences from August 2016 to August 2019 were selected as the research objects. Retrospective research methods were used to divide them into thyroid nodule group and thyroid non nodule group according to the results of thyroid ultrasound examination, and statistical analysis was carried out in combination with relevant data. T-test was used for the comparison between measurement data groups that conform to the normal distribution and χ 2 test was used for the comparison between counting data groups. Binary Logistic regression was used to analyze the relationship between different factors and thyroid nodules, and the odds ratio ( OR) and 95% confidence interval (95% CI) were calculated. Results:(1) The prevalence of thyroid nodules in all population is 28.1% (1 668/5 934), the prevalence of thyroid nodule is 23.1% (977/4 230) in men and 40.6% (691/1 704) in women separately, and the distribution is obviously higher in women than that in male (χ 2=183.13, P=0.008). The prevalence increased with aging in both sexes ( P=0.001). (2) The correlation between the clinical data of physical examination population and thyroid nodules was analyzed according to gender. Among male patients, the rates of BMI≥23.0 kg/m 2 (82.2% (803/977)), diabetes (14.7% (144/977)), hypertension (44.4% (434/977)) and smoking history (63.1% (616/977)) in thyriod nodule group were higher than those in the non thyroid nodule group (78.9% (2 565/3 253), 8% (260/3 253), 29.3% (952/3 253), 56.9% (1 851/3 253)) (χ 2 were 5.17, 39.59, 78.35 and 11.80, respectively; P values were 0.023, 0.009, 0.005 and 0.007, respectively). Among female patients, the rates of BMI ≥23.0 kg/m 2 (55% (380/691)), obesity (31.1% (215/691)), diabetes (6.2% (43/691)), hypertension (28.9% (200/691)), high total cholesterol (43.6% (301/691)), low high-density lipoprotein cholesterol (7.1% (49/691)), high triglycerides (28.4% (196/691)), and high low-density lipoprotein cholesterol (29.1% (201/691)) in thyroid nodule group were higher than those in the non thyroid nodule group (43.6% (442/1 013), 22.5% (228/1 013), 1.9% (19/1 013), 19.2% (195/1 013), 34.7% (352/1 013), 17.9% (181/1 013), 21.5% (218/1 013), 4.5% (46/1 013)), and the differences were statistically significant (χ 2 were 21.23, 15.82, 22.14, 21.68, 13.51, 26.27, 12.69 and 5.08, respectively; P values were 0.007, 0.006, 0.009, 0.007, 0.008, 0.005, 0.005 and 0.024, respectively). (3) Multiple logistic regression analysis reveal that age ( OR=1.530, 95% CI:1.463-1.621, P=0.009), sex ( OR=3.580, 95% CI:2.931-4.381, P=0.005), smoking ( OR=1.360, 95% CI:1.161-1.592, P=0.007) and high blood pressure ( OR=1.290, 95% CI:1.121-1.482, P=0.006) were the risk factors of thyroid nodule. Conclusion:The prevalence of thyroid nodules is 28.1% in XiangYang and surrounding areas, and the elders, women, smoking and high blood pressure were the risk factors of thyroid nodule.

Objective:Analysis of the antibiotic resistance profiles and molecular typing of Salmonella typhimurium ( S. typhimurium) isolated in Wuxi city from 2011 to 2018. Methods:A total of 109 S. typhimurium isolates were detected from different types monitoring samples in Wuxi city from 2011 to 2018. Microbroth dilution method was used to test antimicrobial susceptibility of S. typhimurium for 17 antimicrobial agents. Pulsed field gel electrophoresis (PFGE) was used to conduct molecular typing. Statistical analysis was carried out using Chi-square test. Results:Tetracycline-resistance and ampicillin-resistance were most frequency in 109 S. typhimurium isolates, 69.72% (76/109) and 68.81% (75/109), respectively. For compound sulfamethoxazole, chloramphenicol, ciprofloxacin, ampicillin/sulbactam, azithromycin, nitrofurantoin, cefotaxime and aztreonam, the resistance rates were 23.85%(26/109), 22.02%(24/109), 11.93%(13/109), 4.59%(5/109), 3.67%(4/109), 3.67%(4/109), 0.92%(1/109), 0.92%(1/109), respectively. All isolates were susceptible to amikacin, ertapenem, imipenem, meropenem, ceftazidime and ceftazidime-avibactam. Azithromycin-resistance isolates were decreasing year by year gradually. The aztreonam and cefotaxime-resistant isolates were found since 2018, while chloramphenicol and compound sulfa-resistant isolates showed upward trend simultaneously. Conclusions:S. typhimurium in Wuxi city exhibited highly resistant to tetracycline and ampicillin. The significant variability existed between genotype and phenotype of S. typhimurium.

Objective:To explore the experience of the postoperative adult patients with obstructive sleep apnea-hypopnea syndrome from the patients′ angle and to provide references for improving the postoperative comfort of the patients.Methods:The phenomenology research method was adopted in this study. Thirteen postoperative adult patients with obstructive sleep apnea-hypopnea syndrome from Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology participated in the in-depth interview with the interview outline. Data were analyzed by using Colaizzi′s phenomenological method.Results:Three level-1 themes and ten level-2 themes were extracted. The physical discomfort included throat discomfort, lacking of enough sleep at night, restricted diet, limitation in speaking. The negative emotion included the sense of worry, helplessness, fidget and regret. The wish of support included the wish of coping strategy and being understanded.Conclusions:The main uncomfortable experience of the patients is the throat discomfort which has the chain reaction and causes the other discomfort. So the nurses should inquire patients initiatively, cooperate with doctors and patients′ family members to relieve patients′ discomfort particularly at night, and then the patients′ quality of life, nurse-patient relationship and patients′ satisfaction may be improved.

The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.
Consensus ; Humans ; Oral Ulcer/therapy*

Objective:To understand the genotyping, epidemic characteristics, genetic variation and main epidemic strains of human adenovirus (HAdV) in Wuxi city from 2017 to 2020.Methods:Real-time fluorescence PCR was used to detect the acute respiratory tract infection cases by testing the specimens submitted to sentinel hospitals from 2017 to 2020. The specimens of positive cases tested for nucleic acid were subjected to viral isolation via cell culture, Hexon gene sequencing and analysis were performed to determine genotype and variation.Results:The detection of human adenovirus was slightly different, there were two epidemic peaks in May to July and November to January in Wuxi from 2017 to 2020. The cases were mainly infants (1-3 years old), and the positive samples accounted for 32.05% (75/234). The main clinical symptoms were fever (65.81%), followed by cough (58.12%). There were 8 types of human adenovirus, belonging to 3 subgenera. HAdV-3 has become the main epidemic strain, accounting for 47.18% (67/142), the rest HAdV-7 13.38% (19/142), HAdV-55 7.75% (11/142), HAdV-1 9.15% (13/142), HAdV-2 9.15%(13/142), HAdV-5 5.63%(8/142), HAdV-6 2.11%(3/142), HAdV-4 5.63%(8/142). Compared with 9 domestic reference strains and international (KX384958.1-USA) reference strains, the local epidemic strain HAdV-3 has amino acid mutations at positions 623 and 938 in the evolutionary process.Conclusions:From 2017 to 2020, there are two epidemic peaks. The cases are mainly infants 1 to 3 years old. HAdV-3 has gradually become the dominant epidemic strain, and there are two high frequency mutation sites in the process of pressure selection and evolution.

Objective:To retrieve, appraise and summarize the evidence for the airway humidification management of the inpatient with laryngectomy and tracheotomy but nonmechanical ventilation and to provide references for the clinical nursing.Methods:The evidence question was raised based on the study objective. The evidence was retrieved from some databases according to the evidence pyramid model during inception to December, 2018. The literature types included clinical practice guideline, evidence summary, best practice information sheet, recommended practice and systematic review. The quality of the literature were evaluated by the suitable evaluated tool based on their types. The level and recommedation grade of the evidence were appraised by the suitable tools of JBI.Results:Thirteen studies were recruited, including one clinical practice guideline, two evidence summaries, one best practice information sheet and nine systematic reviews. Totally thirteen items of best evidence were summarized and generalized to four categories including assessment, method, liquid and operation of airway humidification.Conclusion:The evidences of the studies are scientific and practical, but on the one hand, it is recommended that when applying the evidences in clinic, it is necessary to assess the clinical situation and chose the proper evidence. And on the other hand, there are lacking of some evidences of airway humidification and the level of some evidences is low. So it needs to create more high level evidences.

To conduct outbreak identification and transmission factor analysis of typhoid epidemic occurred in Xinqiao town, Jiangyin city from June to September 2016. A total of 14 strains of Salmonella typhi isolated from confirmed cases were collected, and 65 external environment samples and 13 food samples related to the outbreak were taken. Real-time PCR was used to detect specific gene of Salmonella typhi in the samples. Conventional method was used to isolate strains. The strains isolated from both the samples and patients in the epidemic were subjected to antimicrobial susceptibility testing and PFGE molecular characteristics. Salmonella typhi strain was isolated from one external sample (well water of a deli processing plant). The results of drug susceptibility showed that 15 strains were resistant to nalidixic acid. A total of 15 strains of Salmonella typhi were divided into 2 molecular patterns by pulsed field gel electrophoresis. The fingerprints of PFGE from the 13 patients and the environmental isolate were completely consistent, and there was one band difference from the other patient isolate. Combined with the epidemiological investigation and laboratory test results, it was determined that the outbreak was caused by genetic clone of the same Salmonella typhi. Food processing plant should be one of the key links.

To conduct outbreak identification and transmission factor analysis of typhoid epidemic occurred in Xinqiao town, Jiangyin city from June to September 2016. A total of 14 strains of Salmonella typhi isolated from confirmed cases were collected, and 65 external environment samples and 13 food samples related to the outbreak were taken. Real-time PCR was used to detect specific gene of Salmonella typhi in the samples. Conventional method was used to isolate strains. The strains isolated from both the samples and patients in the epidemic were subjected to antimicrobial susceptibility testing and PFGE molecular characteristics. Salmonella typhi strain was isolated from one external sample (well water of a deli processing plant). The results of drug susceptibility showed that 15 strains were resistant to nalidixic acid. A total of 15 strains of Salmonella typhi were divided into 2 molecular patterns by pulsed field gel electrophoresis. The fingerprints of PFGE from the 13 patients and the environmental isolate were completely consistent, and there was one band difference from the other patient isolate. Combined with the epidemiological investigation and laboratory test results, it was determined that the outbreak was caused by genetic clone of the same Salmonella typhi. Food processing plant should be one of the key links.