Objective:To study the clinical characteristics and risk factors of nephrocalcinosis in preterm infants.Methods:From March 2021 to August 2021, all preterm infants admitted to NICU of our hospital were retrospectively analyzed. The infants were assigned into nephrocalcinosis group and non-nephrocalcinosis group according to urinary tract ultrasound. Clinical data including gestational age, birth weight(BW), nutritional support strategy and complications were reviewed.Results:A total of 40 preterm infants (<34 weeks) were enrolled. 9 cases were in the nephrocalcinosis group and 31 cases in the non-nephrocalcinosis group. The nephrocalcinosis group had lower BW[(1 167±214) g vs.(1 586±215) g], higher calcium [6.9 (5.1, 8.7) g vs.3.3 (2.1, 6.8) g] and vitamin D intake [3.2(2.5, 4.2)×10 4U vs.1.7(1.1, 3.2)×10 4U] during hospitalization. No significant differences existed between the two groups on the following items:blood calcium and phosphate, 25-hydroxyvitamin D, feeding strategy, time to reach full enteral feeding(TFF), furosemide dosage and respiratory support duration ( P>0.05). In the nephrocalcinosis group, the median age of diagnosing nephrocalcinosis was 40.0(30.0, 52.5)d after birth. 5 cases showed bilateral nephrocalcinosis. 5 cases in the nephrocalcinosis group received renal tubule function examination,4 cases had increased urine β2 microglobulin and 2 cases had increased urine α1 microglobulin. 7 cases had elevated urine calcium in the nephrocalcinosis group. Follow-up showed that nephrocalcinosis disappeared 3-9 months after birth. Conclusions:BW, total calcium and vitamin D intake are risk factors for nephrocalcinosis in preterm infants. Increased urine β2 microglobulin and calcium levels are common co-morbidities in preterm infants with nephrocalcinosis.

Objective:To observe the long-term effects of conventional disease modifying anti-rheumatic drugs (cDMARDs) in the treatment of ankylosing spondylitis (AS) and drug-related adverse reactions, and provide reference to clinical treatment and assessment.Methods:Retrospective analysis was performed for AS patients with more than 10 years follow-up records in the Department of Rheumatology and Immunology, Peking University Shenzhen Hospital. The AS patients enrolled were treated with cDMARDs, non-steroid anti-inflammatory Drugs (NSAIDs), and glucocorticoidsonl only. The treatment group was treated continuously for at least 3 years, and the control group was untreated or treated for less than 3 months. Clinical symptoms, inflammatory indicators, imaging results and drug-related adverse reactions of all patients were collected for statistical analysis. The counting data were tested by χ2 test, the measurement data in normal distribution was tested by t test, and the measurement data that not normally distributed was tested by mann-whitney U test. Paired test was used for statistical processing before and after treatment. Results:A total of 166 eligible patients were included, including 111 in the treatment group and 55 in the control group. There were no statistical significant differences between the treatment group and the control group at baseline including the mean follow-up time, symptomatic disease course, age, sex ratio, human lymphocyte antigen (HLA)-B27 positive rate, duration of morning stiffness, pain at night, peripheral arthritis, ESR, CRP and imaging data. After 10 years, the treat-ment group had shorter morning stiffness[(8±18) vs (22±34), U=2 228, P=0.008], less nocturnal pain [(2/1.9%) vs (19/36.5%), χ2=37.037, P<0.01], lower ESR level [(14±13) vs (20±19), t=2.249, P=0.026], lower CRP level [(6±6) vs (10±11), t=2.154, P=0.033], lower incidence of peripheral arthritis [(23/20.7%) vs(25/45.5%), χ2=10.946, P=0.001] and lower sacroiliac arthritis progression rate [(28/25.2% ) vs (46/83.6%), χ2=50.922, P<0.01], and lower spinal progression rate [(8/7.2%) vs (51/92.7%), χ2=117.407, P<0.01] compared with the control group. The differences between the two groups was statistically significant. The main medications and drug proportions in the treatment group were as follows: sulfasalazine (100%), methotrexate (86.5%), NSAIDs (98.2%), glucocorticoid (78.4%) and thalidomide (62.2%). The main drug-related adverse reactions that occurred during the treatment included dizziness, abnormal menstruation, and reversible liver dysfunction. Conclusion:The combination of cDMARDs can effectively control the clinical symptoms of most AS patients, reduce inflammation indicators, delay the progression of sacroiliac joint and spinal damage, and have no serious drug-related adverse reactions. Almost all of the untreated AS patients have radiographic progression of the sacroiliac joint and spine.

Objective To observe the clinical characteristics of ankylosing spondylitis (AS) patients with hyperuricemia (HUA), and to understand the correlation between AS and HUA, so as to improve the understanding of AS patients with HUA. Methods A retrospective analysis was carried out in patients with the diagnosis with AS from November 2012 to August 2016. Patients were divided into two groups based on complicated with and without HUA. The clinical manifestations, inflammatory indicators, imaging manifest-ations, treatment and outcomes of the two groups were statistically analyzed, and the follow-up results of some patients with HUA were analyzed. The chi-square test was used for the counting data. The measurement data in line with the normal distribution were tested by t test, and the measurement data in non-normal distribution were tested by Mann-Whitney U test. Results Three hundred and sixty-two patients with AS were collected, consisting of 288 males (79.6％) and 74 females (20.4％), aged from 14 to 72 years, a course of disease was 3 months to 40 years. There were 87 cases (24.0％) with hyperuricemia, 77 cases were male (88.5％, 21.3％of all AS patients), and 10 were female (11.5％, 2.8％ of all AS patients). Shorter morning stiffness time [(13 ±31) min and (22 ±48) min, Z=-2.231, P=0.026], lower IgM level [(1.4 ±1.3) g/L and (3.0 ±4.3) g/L, Z=-2.040, P=0.041], and lower erythrocyte sedimentation rate [(25±17) mm/1 h and (33±22) mm/1 h, t=-2.617, P=0.007] in the HUA group when compared with patients without HUA. The difference between the two groups was statistically significant. Four cases (4.6％) had gout arthritis in the group with HUA, all were male, blood uric acid level all>420 μmol/L. There were 7 cases (8.0％) of urolithiasis in the group with HUA, and 24 cases (8.7％) of urolithiasis in the group without HUA, but there was no statistically significant difference in the incidence of urolithiasis between the two groups. None developed hypertensive disease, heart disease, nephropathy, or diabetis. Conclusion The incidence of hyperuricemia is high in AS, and with lower disease activity, and fewer complications.

Objective To observe the protective effects of oral immunization with Helicobacter pylori (Hp) lysates in combination with mucosal adjuvant dmLT (double mutant heat-labile toxin) against Hp infection in a BALB/ c mouse model and to analyze the features of induced immune responses. Methods BALB/ c mice were orally immunized with Hp lysate (Sydney strain 1, SS1 strain) and dmLT adjuvant, and then innoculated with live Hp strains through oral gavage. A control group was set up by oral administration of normal saline (200 μl/ mouse). The colonization of Hp strains in the stomachs of mice was measured six weeks after bacterial inoculation. Samples of serum, spleen, mesenteric lymph node (MLN), small intes-tine, cecum and feces were collected from mice to analyze the features of induced immune responses. Re-sults The colonization of Hp strains in the stomachs of the immunized mice was significantly decreased as compared with that of the control group. Increased specific IgG antibody responses which were predominantly of IgG1 subtype were detected in the serum samples of the immunized mice and the IgG1 / IgG2a ratio was significantly higher than that of the control group. Elevated secretory IgA (sIgA) was detected in the samples of small intestine, cecum and feces in the immunization group, especially in the small intestine samples, while no significant change in sIgA secretion was observed in the control group. The percentages of IL-17+CD4+ T cells in spleen and mesenteric lymph nodes of the immunization group were significantly higher than those of the control group. Conclusions Oral immunization with Hp lysates in combination with adjuvant dmLT induced mucosal and systemic immune responses and enhanced the resistance to Hp colonization in BALB/ c mice, which was associated with the significantly increased Th17 immune responses and Th2 polari-zation. This study provided reference for further evaluation of dmLT as a mucosal adjuvant in the develop-ment of recombinant protein vaccines against Hp infection.

Objective To evaluate the adjuvant activities of cyclic guanosine monophosphate-adenosine monophosphate ( cGAMP) in enhancing humoral and cellular responses against Helicobacter pylori ( H. pylori) . Methods BALB/c mice were immunized with the protein antigens including UreA, UreB and NapA of H. pylori in combination with cGAMP as the adjuvant on 0 d and 14 d by subcutaneous administra-tion. Then, the serum-specific antibody responses were evaluated by ELISA. Flow cytometry ( FCM) and enzyme-linked immunospot assay ( ELISpot) were used to detect the cellular immune responses occurred in spleen and mesenteric lymph nodes (MLN). Results Subcutaneous administration of protein antigens of H. pylori together with cGAMP induced strong humoral and cellular immune responses in BALB/c mice. The levels of serum-specific IgG antibodies induced by adding cGAMP as the adjuvant were significantly higher than those by immunizing with antigens alone. The levels of splenic IFN-γ-producing lymphocytes in re-sponse to H. pylori antigens and cGAMP immunization were significantly higher than those in the correspond-ing groups without using cGAMP. Conclusion By using cGAMP as an adjuvant, H. pylori antigens could elicit significantly stronger humoral and cellular immune responses in mice than those induced by the anti-gens only. As a stable small molecular compound with strong adjuvant activity, cGAMP has the potential to be used for the development of H. pylori vaccine.

Objective To analyze the urine trace albumin(mALb)/creatinine(Cr) ratio and blood uric acid(UA),and other various metabolic index level in patients with diabetic nephropathy(DN),combined with clinical data such as patients' age,body mass index(BMI),course of diseases,to explore the related mechanism of occurrence and development of DN.Methods 76 DN patients were selected.The microalbuminuria group(urinary mALb/Cr<300μg/mg) had 46 cases,the clinical albuminuria group(urinary mALb/Cr≥300μg/mg) included 30 cases,another 49 diabetic patients without kidney damage were seleted as control group.The urinary mALb/Cr,blood UA,fasting blood glucose(FBG),triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein(HDL),low density lipoprotein(LDL),glycosylated hemoglobin(HbA1c) levels were determined.The BMI and the length of the course of the disease calculate.Results The patients' age,course of the disease,urinary mALb/Cr,blood UA,FBG,TC,TG,LDL,HbA1c and BMI level in the clinical albuminuria group and microalbuminuria group were significantly higher than those in the control group,the differences were statistically significant (F=6.18,12.48,141.43,12.48,8.49,4.98,6.18,3.89,3.17,3.89,all P<0.05).The high uric acid hematic disease rates of the clinical albuminuria group and microalbuminuria group were 26.09% and 26.09%,which were significantly higher than 10.20% of the control group,the differences were statistically significant(x2=4.074,24.833,all P<0.05).Urinary mALb/Cr was positively correlated with age,duration,BMI,UA,TG,TC,LDL,FBG,HbA1c(r=0.120,0.299,0.148,0.340,0.157,0.149,0.103,0.487,0.103).Multiple linear stepwise regression analysis suggested that duration,blood UA,FBG were independent risk factors of urinary mALb/Cr;TG,BMI,urinary mALb/Cr were independent risk factors for blood UA.Conclusion Urinary mALb/Cr and blood UA are the independent risk factors,high uric acid hematic disease may participate in the development process of DN,and diabetes duration,UA,BMI,TG,TC,LDL,FBG,HbA1C associated with increased urinary mALb/Cr excretory DN patients,the effective monitoring can improve the symptoms of DN and quality of life.

Objective To evaluate the immunopotentiating effect of cyclic guanosine monophos-phate-adenosine monophosphate (cGAMP) as an adjuvant on norovirus (GⅡ. 4) virus like particles (VLPs) in the development of norovirus vaccine. Methods BALB/c mice were intramuscularly immunized with norovirus (GⅡ.4) VLPs composed of capsid protein VP1 in combination with cGAMP or Al(OH)3. Norovirus VLPs-specific antibodies in serum were detected by ELISA. A synthetic histo-blood group antigen (HBGA)-VLPs blocking assay was used to analyze neutralizing antibodies against norovirus VLPs in serum samples. Results Immunization with norovirus VLPs in the presence of cGAMP induced a strong humoral immune response in BALB/c mice. Levels of specific IgG antibodies in serum induced by using cGAMP as the adjuvant were significantly higher than those induced by using Al(OH)3adjuvant when immunization of BALB/c mice with the same dosage of VLPs. The antibody level induced by 1 μg of VLPs in combination with cGAMP was equivalent to that elicited by 10 μg of VLPs combined with Al(OH)3adjuvant. Results of the synthetic HBGA-VLPs blocking assay showed that the blocking rate in cGAMP+VLPs immunization group were significantly higher than that in Al(OH)3+VLPs immunization group when using the same dosage of VLPs. No significant difference in blocking rate was observed between cGAMP+VLPs(1 μg) and Al(OH)3+VLPs (10 μg) immunization groups. Conclusion cGAMP significantly enhanced the specific humoral immune response induced by norovirus (GⅡ.4) VLPs in mice as compared with Al(OH)3adjuvant. It might be used as a novel adjuvant to replace the traditional aluminum adjuvant in the development of norovir-us vaccine.

Objective To explore effect of pre-programmed guidance of functional exercise on exercise compliance and accuracy of patients after lumbar surgery.Methods From January to March 2016, 60 patients who had undergone the surgery of lumbar spine internal fixation were selected as the research object. All patients were divided into intervention group and control group randomly, 30 patients in each group. Patients in the control group underwent routine postoperative functional exercises. Patients in the intervention group received preoperative functional exercise instruction before 2 days. According to the self-designed questionnaire, we evaluated the compliance and accuracy of functional exercises of the two groups by asking, checking and demonstrating.Results At first day after operation, the proficiency on ankle pump exercises and straight-leg-raising movement showed no significant difference between two groups (P>0.05); However, on supine siding leg movement to right-left, compared with the control group, the intervention group were significantly better (Z=-5.100,P<0.001). At first day after removing wound drains, the proficiency on ankle pump exercises and raising buttock with five positions showed no significant difference between two groups (P>0.05), but on straight-leg-raising movement (Z=-2.316,P=0.021) , supine siding leg movement to right-left (Z= -4.238,P<0.001), lateral siding leg movement to front-back (Z=-3.027,P=0.002) and lateral straight-leg-raising movement (Z=-3.027,P=0.002), the intervention group was significantly better than the control group. Moreover, as far as adherence of exercise, patients in the intervention group were obvious better (Z= -2.156,P=0.031).Conclusions The pre-programmed guidance of functional exercise can improve the patient's awareness and confidence of functional exercise on rehabilitation, reduce the patients' psychological anxiety, so as to improve the compliance and the correct rate of functional exercise, promote their recovery. It also can save time for propaganda, improve work efficiency.

OBJECTIVE:To study the correlation between antibacterials amount and drug resistance of Echerichia coli,and to provide reference for clinical use of antibacterials. METHODS:Retrospective review was used to calculate DDDs of antibacterials and resistance rate of Escherichia coli to 11 kinds of antibacterials each quarter. The correlation analysis was carried out using the SPSS 13.0 statistical software. RESULTS:The resistance rates of E. coli to piperacillin/tazobactam,cefoperazone/sulbactam and le-vofloxacin were with upward trends,and the others showed downward trends. The resistance rates of E. coli to meropenem and imi-penem/cilastatin appeared in 2014,increasing from 0 to 8.8% and 9.4%,respectively. DDDs of them were significantly correlated to drug resistance of E. coli,showing positive correlation(r=0.915,0.793,P<0.01). DDDs of piperacillin/tazobactam was signif-icantly correlated to resistance rate of E. coli(r=0.807,P<0.01),while that of ceftazidime was negatively correlated to resistance rate of E. coli(r=-0.672,P<0.05). There was no statistical significance in resistance rate of E. coli to other 7 kinds of antibacte-rials. CONCLUSIONS:There are some correlations between the DDDs and resistance rates. We should strengthen the monitoring of bacterial resistance and the management of rational application of antibacterials.

Objective To explore the feasibility of the digital grading scale applied for assessment of anxiety by nurses. Methods Firstly, the digital grading scale was made, and then it was applied for patients guided by nurses to evaluate their anxiety level by themselves within 24 hours and at 3 weeks after admission. Anxiety level of the same crowd guided by doctors was also evaluated independently with Hamilton Anxiety Scale ( HAMA) by blind method. Results The correlation coefficent of the score between the digital grading scale and HAMA was 0. 794 (P<0. 01), and the score between them was positively related. Scores of the digital grading scale were compared with HAMA whose scores were divided into 5 groups according to severity level with significant differences (P <0. 01). Conclusions The digital grading scale has an obvious correlation with HAMA and it can be used to evaluate anxiety level in patients with generalized anxiety disorder.