Objective To investigate the dietary patterns of rural residents in the high-incidence areas of esophageal cancer (EC), and to explore the clustering and influencing factors of risk factors associated with high-incidence characteristics. Methods A special structured questionnaire was applied to conduct a face-to-face survey on the dietary patterns of rural residents in Yanting county of Sichuan Province from July to August 2021. Univariate and multivariate logistic regression models were used to analyze the influencing factors of risk factor clustering for EC. Results There were 838 valid questionnaires in this study. A total of 90.8% of rural residents used clean water such as tap water. In the past one year, the people who ate fruits and vegetables, soybean products, onions and garlic in high frequency accounted for 69.5%, 32.8% and 74.5%, respectively; the people who ate kimchi, pickled vegetables, sauerkraut, barbecue, hot food and mildew food in low frequency accounted for 59.2%, 79.6%, 68.2%, 90.3%, 80.9% and 90.3%, respectively. The clustering of risk factors for EC was found in 73.3% of residents, and the aggregation of two risk factors was the most common mode (28.2%), among which tumor history and preserved food was the main clustering pattern (4.6%). The logistic regression model revealed that the gender, age, marital status and occupation were independent influencing factors for the risk factors clustering of EC (P<0.05). Conclusion A majority of rural residents in high-incidence areas of EC in Yanting county have good eating habits, but the clustering of some risk factors is still at a high level. Gender, age, marital status, and occupation are influencing factors of the risk factors clustering of EC.

ObjectiveTo explore the effect of targeted intervention measures based on risk score of venous thromboembolism （VTE）， on the prevention of senile type 2 diabetes inpatients， as well as their influence on the occurrence of venous thromboembolism. MethodsA total of 134 elderly patients with type 2 diabetes mellitus who were hospitalized in geriatrics department of Peking university third hospital during June 1， 2018 to September 30， 2018 were selected as the research subjects. All the patients were divided into control group and observation group according to random number table method， with 67 patients in each group. Patients in the control group were treated with conventional intervention methods， and patients in the observation group were treated with targeted intervention measures based on VTE risk score. After one month of intervention， the Padua score， blood glucose level and coagulation indexes of the two groups were compared. The incidence of thrombosis during the intervention period was also recorded. ResultsThe Padua score in observation group （2.09±2.17） points was significantly lower than that （3.19±2.37） points in control group （P<0.05）. The indexes of fasting blood glucose， 2h postprandial blood glucose and HbA1c in observation group were significantly lower than those in control group （P<0.05）. The fibrinogen， D-dimer， activated partial thromboplastin time and prothrombin time in observation group were significantly lower than those in control group （P<0.05）. The incidence of DVT， PVT， lower limb swelling， pain and abnormal skin color in the observation group were 4.00%， 2.00%， 2.00%， 2.00%， and 0， respectively， and in the control group were 12.00%， 10.00%， 10.00%， 12.00%， and 8.00%， respectively. The incidence of adverse events in observation group was significantly lower than that in control group （P<0.05）. ConclusionTargeted intervention based on VTE risk score can significantly reduce the risk of VTE occurrence， improve blood clotting function and blood glucose level in elderly patients with type 2 diabetes mellitus. This nursing measure has important clinical application value.

Objective To predict the structure and antigenic epitope of the Strongyloides stercoralis serine protease inhibitor 1 (Ss-SRPN-1) protein using bioinformatics tools, and to construct prokaryotic expression plasmids for expression of recombinant Ss-SRPN-1 protein, so as to provide the basis for unraveling the function of the Ss-SRPN-1 protein. Methods The amino acid sequence of the Ss-SRPN-1 protein was downloaded from the NCBI database, and the physicochemical properties, structure and antigenic epitopes of the Ss-SRPN-1 protein were predicted using bioinformatics tools, including ExPASy, SWISS-MODEL and Protean. Primers were designed according to the nucleotide sequences of Ss-SRPN-1, and the Ss-SRPN-1 gene was amplified, cloned and sequenced with genomic DNA extracted from the infective third-stage larvae of S. stercoralis as a template. The Ss-SRPN-1 protein sequence was cloned into the pET28a (+) expression vector and transformed into Escherichia coli BL21 (DE) cells for induction of the recombinant Ss-SRPN-1 protein expression. The recombinant Ss-SRPN-1 protein was then purified and identified using Western blotting and mass spectrometry. Results Bioinformatics analysis showed that the Ss-SRPN-1 protein, which was composed of 372 amino acids and had a molecular formula of C₁₉₄₈H₃₀₄₆N₄₈₈O₅₇₅S₁₆, was a stable hydrophilic protein, and the subcellular localization of the protein was predicted to be extracellular. The Ss-SRPN-1 protein was predicted to contain 11 dominant B-cell antigenic epitopes and 20 T-cell antigenic epitopes. The Ss-SRPN-1 gene with a length of 1 119 bp was successfully amplified, and the recombinant plasmid pET28a (+)/Ss-SRPN-1 was constructed and transformed into E. coli BL21(DE) cells. The expressed recombinant Ss-SRPN-1 protein had a molecular weight of approximately 43 kDa, and was characterized as a Ss-SRPN-1 protein. Conclusions The recombinant Ss-SRPN-1 protein has been expressed successfully, and this recombinant protein may be a potential vaccine candidate against strongyloidiasis.

Objective:To formulate a blueprint for the care of radiotherapy-induced oral mucositis (RIOM) in patients with nasopharyngeal carcinoma, to implement and observe the effect.Methods:Using the convenient a sampling method, a total of 182 patients with nasopharyngeal carcinoma who underwent radiotherapy and chemotherapy in Cancer Hospital of The University of China Academy of Sciences from July 2019 to June 2020 were selected as the research objects. A total of 91 patients from July to December 2019 were set as the control group and they received conventional radiotherapy care. A total of 91 patients from January to June 2020 were set as the intervention group. On the basis of the control group, the intervention group adopted conventional radiotherapy nursing and implemented the care blueprint based on the action study method. The incidence, severity and pain of RIOM were compared between the two groups.Results:In the 3rd to 5th week of radiotherapy, the incidences of RIOM in the intervention group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . At week 3 and after radiotherapy, the severity of RIOM in the intervention group were less than those in the control group, and the differences were statistically significant ( P <0.05) . At the end of radiotherapy, the degree of oral pain in the intervention group was lighter than that in the control group, and the difference was statistically significant ( P< 0.05) . Conclusions:RIOM care blueprint constructed in this study is scientific and valid. Evidence-based RIOM care blueprint can reduce the incidence and severity of RIOM in nasopharyngeal cancer patients and relieve oral pain, which is worthy of clinical application.

Objective:To investigate the changes and clinical significance of serum S100β and neuron-specific enolase (NSE) levels of children with acute brain injury(ABI).Methods:100 children with ABI treated in the pediatric intensive care unit (PICU) of the Affiliated Hospital of Inner Mongolia Medical University from June 2019 to June 2020 were prospectively selected as the ABI group, and 30 normal children in the children′s health clinic of the hospital were selected as the control group. The serum S100β and NSE levels of all subjects was detected. According to the Glasgow Coma Scale (GCS), children with ABI were divided into severe brain injury group ( n=26), moderate brain injury group ( n=35) and mild brain injury group ( n=39). The prognosis of children with ABI after 3 months of treatment was evaluated according to the Glasgow prognosis scale (GOS) and they were divided into poor prognosis group ( n=26) and good prognosis group ( n=74). The relationship between serum S100β and NSE levels and the severity and prognosis of children with ABI was analyzed. Results:The serum S100β and NSE levels in the ABI group were significantly higher than those in the control group, and the serum S100β and NSE levels in children with ABI increased with the severity of injury and poor prognosis ( P<0.05). Pearson correlation analysis showed that serum S100β and NSE levels in children with ABI were positively correlated with GCS scores ( r=0.521, 0.643, P<0.05). Multiple logistic regression analysis showed that glucose(GLU) ( OR=1.631, 95% CI: 1.278-2.082), S100β ( OR=1.907, 95% CI: 1.558-5.877), NSE ( OR=2.896, 95% CI: 1.193-7.029) were independent prognostic factor in children with ABI ( P<0.05). Receiver operating characteristic (ROC) curve showed that the sensitivity, specificity and accuracy of serum S100β+ NSE [area under curve (AUC)=0.932, 95% CI: 0.875-0.969] in predicting the poor prognosis of children with ABI were higher than those of serum S100β(AUC=0.728, 95% CI: 0.643-0.803), NSE (AUC=0.808, 95% CI: 0.729-0.871) alone. Conclusions:The levels of serum S100β and NSE in children with ABI aresignificantly increased, which are closely related to the severity of the disease and prognosis. They can be used as predictors of poor prognosis in children with ABI. Combined detection can enhance the diagnostic value.

Objective:To explore the predictive value of artificial intelligence algorithm model for venous thromboembolism（VTE）in lower extremities of trauma patients.Methods:The data of 15，856 orthopedic inpatients were retrospectively collected from the information system database in Chinese PLA General Hospital from December 1992 to November 2017. The patients were divided according to whether they had thrombosis or not. Data pretreatment and feature extraction were carried out. Four artificial intelligence algorithms including Random Forest（RF），Bayes（Bayes），Decision Tree（DTC）and Gradient Boosting Tree（GBDT）were constructed to evaluate their clinical diagnostic efficacy in VTE. The original data were divided into training set and test set according to the ratio of 8∶2 by random stratified sampling method. By comparing the area under receiver operating characteristic curve（ROC）（AUC），true positive rate（TPR）and accuracy in the above methods，the efficiency of different models in clinical diagnosis of VTE was evaluated. According to the contribution degree of the features in the model，the important features were ranked to screen the independent risk factors of VTE.Results:For RF，Bayes，DTC and GBDT algorithm models，the AUC was 0.89，0.86，0.68，0.71，with the TPR for 0.29，0.44，0.38，0.66 and the accuracy for 0.97，0.94，0.95，0.76，respectively. The RF algorithm model had the highest accuracy and the largest AUC. Analysis of important features of artificial intelligence prediction models for VTE showed that the history of thrombosis was the primary predictor of adverse outcomes. The ranking of important clinical features represented by the RF model showed that the history of thrombosis，enoxaparin sodium injection dose，last glucose measurement and first glucose measurement after surgery were important predictive characteristics of VTE.Conclusions:The RF model has the highest accuracy in risk prediction of VTE in trauma patients，which can provide a reference for the formulation of VTE prevention strategies.

Objective:To investigate the value of the size-specific dose estimate (SSDE) on dose estimations of children's head CT scans.Methods:A retrospective study was conducted on plain head CT scans of 252 patients with the 64-row detector CT device of Discovery 750HD in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to September in 2019. The volume CT dose index (CTDI vol)values were recorded. The head circumference (HC), area, and CT value were measured using a self-developed computer program, and the water equivalent diameter (WED), size-specific conversion factors ( f293 and f220), and absorbed dose (SSDE 293 and SSDE 220) were calculated according to the AAPM reports 293 and 220.The patients were divided into three groups by the quartering meth odaccording to their HC(<47.8 cm, 47.8-52.7 cm, >52.7 cm)and four groups based on their ages(0-2, 3-6, 7-10 and 11-14 years old). The difference between parameters ( f220 and f293, SSDE 220 and SSDE 293、SSDE 293 and CTDI vol) were compared for different groups, and the correlation of HC with f293 and SSDE 293 was analyzed. Results:There was an overestimation of f220 by 11.11% ( t=252.61, P<0.05) compared with f293. SSDE 220 was overestimated by 10.31% ( t=228.21, P<0.05) compared with SSDE 293, and SSDE 293 was underestimated by 9.60% ( t=-31.34, P<0.05)compared with CTDI vol. For the three HC groups, SSDE 220 was overestimated by 8.54%, 10.37%, and 11.57% ( t=73.73, 438.58, 275.52, P<0.05)compared with SSDE 293, and SSDE 293 was underestimated by 1.30%, 9.79%, and 14.61% ( t=-1.91, -60.95, -47.64, P<0.05)compared with CTDI vol. For the four age groups SSDE 220 was overestimated by 8.45%, 10.00%, 10.57%, and 11.36% ( t=63.58, 232.29, 247.84, 302.95, P< 0.05)compared with SSDE 293, and SSDE 293 was underestimated by 1.49%, 8.27%, 10.63%, and 13.78% ( t=-1.83, -28.27, -37.30, -49.80, P< 0.05)compared with CTDI vol. Furthermore, HC was highly correlated with f293 and SSDE 293 ( r2=0.88 and 0.76, respectively, P< 0.05). Conclusions:The radiation dose in children′s head CT scanning can be more accurately estimated according to the AAPM Report 293, while it can be overestimated by CTDI vol. Meanwhile, the CT radiation dose can be patently overestimated with the AAPM Report 220 compared with Report 293.HC is closely correlated with f293 and SSDE 293 and it can be used to estimatee more accurately for SSDE and the radiation dose received by children during head CT scanning.

Evidence-based medicine (EBM) is an emerging subject which allows us to make health-related policy based on evidence, and is also an important course in medical colleges and universities. Given the current educational objectives and characteristics of evidence-based medicine, this paper proposed an online and offline integrated teaching model of evidence-based medicine based on online platform for medical undergraduates. Online teaching was conducted using online platform which focus on the cultivation of evidence-based thinking and scientific research quality. Offline teaching was in-classroom teaching which focus on basic knowledge and skill learning. Practice of this model not only enriches teaching methods, but also improves the learning effect, thus this model needs to be explored and perfected in the future.

Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.

Carbon dioxide (CO 2) ejection syndrome is common after artificial pneumoperitoneum, and it often attracts the attention of anesthesiologists because of its rapid changes in vital signs. CO 2 ejection syndrome is not uncommon in critically ill patients, and may occur after mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There are few relevant reports about CO 2 ejection syndrome, and a considerable number of clinicians have little understanding of the pathological changes. A case of AECOPD patient with CO 2 ejection syndrome after endotracheal intubation was admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University. After treatment, such as fluid expansion, vasoactive drugs and ventilator assistance, the patient's condition improved and was transferred out of the ICU. It is expected to provide some references by summarizing the diagnosis and treatment of this case and reviewing relevant literature reports.