Objective To explore the risk factors of supplementary injection after foam sclerotherapy for varicose veins of lower extremities and its impact on blood coagulation function.Methods A total of 185 patients with varicose veins of lower limbs diagnosed in the First People's Hospital of Zunyi from January 2018 to December 2021 were selected.The corresponding pathological data were collected,and the D-dimer,thrombin time,and fibrinogen level of patients were detected 1 d before and 1 d after the surgery.The postoperative video phone follow-up lasted until 6 months after the surgery.The patients were divided into single treatment group and supple-mentary treatment group according to whether supplementary injection of foam sclerosing agent was needed during the follow-up.Propensity matching on the data between the two groups was conducted,and the correlation between disease course data,coagulation factors,and the occurrence of supplementary injection was analyzed.A time series model for the incidence of supplementary injection was established,and the therapeutic effect and complica-tions were observed.Results After propensity matching,there was still significant difference in the degree of lesion between the two groups(P<0.05).On the first day after surgery,there was significant difference in the D-dimer and fibrinogen groups between the two groups(P<0.05),and but no significant difference in thrombin time(P>0.05).The occurrence of supplementary injection was significantly correlated with D-dimer,fibrinogen,thrombin time,and first-time injection dose(P<0.05),and the incidence of supplementary injection was higher in patients who received first-time injection in January,August,September,and December.Both groups achieved successful treatment 6 months after surgery,and there was no significant difference in the incidence of compli-cations.Conclusion Patients with lower limb varicose veins of C3/C4 are more likely to require supplementary injection compared to patients with other levels.The level of D-dimer and fibrinogen at 1 d after surgery is positively correlated with the occurrence of supplementary injection,while the dose of the first injection is negatively corre-lated with the occurrence of supplementary injection.

ObjectiveTo investigate the association between spontaneous portosystemic shunt （SPSS） and hepatorenal syndrome （HRS） in patients with liver cirrhosis. MethodsA retrospective analysis was performed for 93 patients with SPSS from Dezhou Hospital， Qilu Hospital of Shandong University， from January 2015 to January 2022， and the patients were followed up for 12 months with the onset of HRS as the observation endpoint. According to the presence or absence of HRS， the 93 patients with SPSS were divided into HRS group with 38 patients （40.86%） and non-HRS group with 55 patients （59.14%）， and the two groups were compared in terms of clinical data， laboratory data， complication， and shunt diameter. Based on the maximum shunt vein diameter of 1.5 cm， the 93 patients with SPSS were divided into high shunt group with 52 patients （55.91%） and low shunt group with 41 patients （44.09%）， and with the onset of HRS as the observation endpoint， the two groups were compared in terms of the incidence rate of HRS and survival time curve. The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic （ROC） curve was used to predict cut-off values， the Kaplan-Meier curve was used for comparison of survival time， and the Log-rank test was used to compare the differences in survival curves. The multivariate Cox regression analysis was used to investigate risk factors. ResultsCompared with the non-HRS group， the HRS group had significant increases in Child-Pugh score， Child-Pugh class， MELD score， serum creatinine， blood urea nitrogen， alanine aminotransferase， aspartate aminotransferase， maximum shunt vein diameter， the incidence rates of hepatic encephalopathy and spontaneous bacterial peritonitis， and the degree of ascites， as well as significant reductions in main portal vein diameter， serum sodium and albumin （all P<0.05）. Compared with the low shunt group， the high shunt group had a significant increase in the incidence rate of HRS （51.92% vs 26.83%， χ²=5.974， P=0.015） and a significant reduction in the time to the onset of HRS （Log-rank P=0.033）. A maximum shunt vein diameter of >1.5 cm （hazard ratio ［HR］=1.123， 95% confidence interval ［CI］： 1.041‍ ‍—‍ ‍1.211， P=0.003）， an increase in MELD score （HR=1.205， 95%CI： 1.076‍ ‍—‍ ‍1.437， P=0.039）， a reduction in serum albumin （HR=0.890， 95%CI： 0.814‍ ‍—‍ ‍0.974， P=0.011）， an increase in the degree of ascites （HR=2.099， 95%CI： 1.066‍ ‍—‍ ‍4.130， P=0.032）， and spontaneous bacterial peritonitis （HR=2.259， 95%CI： 1.020‍ ‍—‍ ‍5.003， P=0.045） were independent risk factors for the onset of HRS in SPSS patients. ConclusionThere is an association between SPSS and HRS， and shunt diameter >1.5 cm was an independent risk factor for HRS in SPSS patients， which should be taken seriously and require early intervention in clinical practice.

Objective:To investigate the expression of serum angiopoietin-2(Ang-2)in elderly community acquired pneumonia(CAP)patients and to evaluate the correlation between Ang-2 levels and the severity of CAP.Methods:As a case-control study, a total of 118 hospitalized elderly CAP patients were selected.According to the severity of CAP, patients were divided into the general pneumonia group( n=67)and the severe pneumonia group( n=51). At the same time, 40 elderly healthy people without pneumonia were selected as the control group.Serum Ang-2, interleukin-6(IL-6), procalcitonin(PCT)and C-reactive protein(CRP)levels were measured, and CURB-65 scores were obtained for patients with CAP. Results:Serum levels of Ang-2, IL-6, PCT and CRP in elderly CAP patients were significantly higher than those in the control group, and the differences were statistically significant( H=70.698, 25.752, 15.982, 30.588, all P<0.001). Spearman correlation analysis showed that Ang-2 levels were positively correlated with IL-6, PCT, CRP, and CURB-65 scores( r=0.715, 0.531, 0.558, 0.450, all P<0.001). Using Ang-2 as a predictor for severe pneumonia in community-dwelling elderly patients, the area under the ROC curve(AUC)was 0.866(95% CI: 0.809-0.924), the optimal cutoff point was 5.24 μg/L, and the corresponding sensitivity and specificity were 72.5% and 84.1%. Conclusions:Serum Ang-2 levels in elderly patients with CAP are significantly higher than those in healthy people, and are correlated with the severity of CAP.The detection of Ang-2 levels is helpful for early intervention management and improved prognosis of elderly CAP patients.

Objective:To explore the effects of LERANS-based health education in nursing of patients with diabetic retinopathy (DR) .Methods:Totally 150 DR patients hospitalized at the First Affiliated Hospital of Xinjiang Medical University from January 2018 to June 2020 were selected and divided into a control group and an observation group according to the random number table, with 75 patients in each group. Patients in the control group received routine health education, while patients in the observation group underwent LERANS-based health education. The Evaluation of Self-care Ability (ESCA) , Diabetes-Specific Quality of Life (DSQL) and the DR Patient Positive Psychological Capital Questionnaire were used to evaluate the self-care ability, quality of life, and psychological capital of the two groups before and after the intervention.Results:Before the intervention, there was no statistically significant difference in the scores of ESCA, DSQL, and DR Patient Positive Psychological Capital Questionnaire between the two groups ( P>0.05) . After intervention, 4 dimensions scores of ESCA and the scores and DR Patient Positive Psychological Capital Questionnaire in the observation group were higher than those in the control group, and the total score of DSQL was lower than that in the control group, with statistically significant differences ( P<0.05) . Conclusions:LERANS-based health education can effectively improve the psychological capital of DR patients and enhance their self-care ability and quality of life, which is worth promoting in clinical practice.

Objective:To develop the Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients suitable for China, and to test its reliability and validity.Methods:Guided by the theory of knowledge, attitude and practice, a questionnaire framework was constructed, and the first draft of the Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients was formed through literature review, group discussion, semi-structured interview, Delphi expert consultation and pre-investigation. From June to August 2020, convenience sampling was used to select 120 osteoporosis patients admitted to the First Affiliated Hospital of Soochow University as the research object to conduct a questionnaire survey to test the reliability and validity of the questionnaire. A total of 120 questionnaires were distributed, 110 valid questionnaires were recovered, and the valid recovery rate was 91.67% (110/120) .Results:Among 2 rounds of Delphi expert consultation, the expert authority coefficients were 0.880 and 0.900, respectively, and the Kendall harmony coefficients were 0.308 and 0.332, respectively, with statistically significant differences ( P<0.01) . The Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients included two sub-questionnaire of knowledge and behavior, with a total of 19 items, including 10 items in knowledge and 9 items in behavior. Exploratory factor analysis showed that 2 common factors were extracted from the exercise knowledge sub-questionnaire, and the cumulative variance contribution rate was 60.712%. A total of one common factor was extracted for the exercise behavior sub-questionnaire, and the cumulative variance contribution rate was 72.075%. The content validity index of the total questionnaire and each sub-questionnaire were 0.925, 0.921, and 0.929, respectively, and the item-level content validity index of was 0.857 to 1.000. The Cronbach's α coefficients of the total questionnaire and each sub-questionnaire t were 0.935, 0.830, and 0.953, respectively, and the split-half reliability coefficients of the total questionnaire and each sub-questionnaire were 0.979, 0.898, and 0.974, respectively, and the test-retest reliability coefficients of the total questionnaire and each sub-questionnaire were 0.878, 0.813, 0.860, respectively. Conclusions:The Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients has good reliability and validity, and can be used to evaluate exercise knowledge and behavior in patients with osteoporosis.

Objective:To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) and CURB-65 score in elderly patients with community acquired pneumonia (CAP).Methods:A total of 160 elderly CAP patients who were treated in Department of Respiratory and Critical Care Medicine of the Third Affiliated Hospital of Anhui Medical University between January 2019 and March 2020 were retrospectively analyzed. According to the 30-day survival, the patients were divided into the survival group ( n=127) and the death group ( n=33). The general clinical data, blood routine, liver and kidney function, blood sodium, coagulation function, C-reactive protein and procalcitonin were collected, and NLR and CURB-65 scores were calculated. Pass t-test or χ2 test was used to compare the differences of the above indexes between the two groups, and the high-risk factors of 30-day death in elderly CAP patients were screened by multivariate Logistic regression analysis; receiver operating characteristic curve (ROC) was drawn, and the predictive value of NLR and CURB-65 score on the risk of death was analyzed. Results:Compared with the survival group, the patients in the death group were older and had a higher proportion of neurological diseases and chest tightness symptoms ( P<0.05). The total number of lymphocytes, hemoglobin, and serum albumin were significantly decreased, and the total neutrophil count, blood urea nitrogen, D-dimer, NLR, C-reactive protein, procalcitonin and CURB-65 score were significantly increased in the death group (all P <0.05). Multivariate Logistic regression analysis showed that NLR and CURB-65 score were the independent risk factors of 30-day mortality in elderly CAP patients ( P<0.01). ROC survival curve showed that the area under the curve (AUC) of NLR was 0.823 [95% CI (0.747 ~ 0.900)], the cut-off value was 8.885, and the sensitivity and specificity of prognosis were 84.8% and 74.8%. The AUC of NLR combined with CURB-65 score was 0.872 [95% CI (0.801 ~ 0.942)], the cut-off value was 0.248, and the sensitivity and specificity of prognosis were 84.8% and 84.3%. The combination of the two indexes had better prognostic value than other independent evaluation indexes. Conclusions:NLR and CURB-65 scores are high risk factors of death in elderly CAP patients. The combination of the two indicators can better predict the risk of death.

Objective The radioactivity level survey was carried out in Weizhou Island area of Beihai, to comprehensively master the radiation environment status in the area, understand the natural radioactivity level and its distribution law, and provide basic data for scientific evaluation of radiation environment quality. Methods According to the relevant standards and technical specifications, the air absorbed dose rate of gamma radiation in Weizhou Island area was monitored from April 2020 to March 2021, the concentrations of radionuclides in water, soil and other environmental samples were sampled and analyzed, and the monitoring results were analyzed and discussed in combination with the regional characteristics. Results The results show that the air absorbed dose rate of gamma radiation in Weizhou Island area ranges from 0.2～122 nGy/h; the activity concentrations of ²³⁸U, ²²⁶Ra, ²³²Th, ⁴⁰K and ¹³⁷Cs in solid samples range 17.0～37.3 Bq/kg, < 0.501～29.5 Bq/kg, < 0.766～54.3 Bq/kg, 18.7～369 Bq/kg and < 0.212～1.48 Bq/kg, respectively, the concentrations of U and Th in well water and reservoir water range 0.065～0.25 μg/L, 0.046～0.079 μg/L, the activities of ²²⁶Ra, ⁴⁰K, total α and total β range 1.42～3.08 mBq/L, 0.069～0.231 Bq/L, 0.025～0.163 Bq/L, 0.082～0.572 Bq/L, respectively, the concentrations of U and Th in seawater samples range 1.81～2.25 μg/L, 0.634～0.648 μg/L, and the activities of ²²⁶Ra, ⁴⁰K, ⁹⁰Sr and ¹³⁷Cs range 9.38～19.7 mBq/L, 11.3～11.8 Bq/L、0.193～0.866 mBq/L、1.13～1.42 mBq/L. Conclusion The environmental ionizing radiation level in Weizhou island of Beihai is in the range of background fluctuation and at a relatively low level, indicating that the radiation environmental quality of Weizhou Island and its surrounding areas is good.

Objective:To understand the status quo of nurses' knowledge, attitude and behavior towards secondary prevention of coronary heart disease (CHD) , so as to provide basis for the standardization of secondary prevention management of CHD.Methods:From July to August 2020, a total of 1 087 nurses in the Cardiovascular Department of 20 comprehensive hospitals (12 ClassⅢ hospitals and 8 ClassⅡ hospitals) and 1 ClassⅢ Grade A Cardiovascular Hospital in 11 cities of Shanxi Province were selected as the research subjects by convenience sampling method. The self-designed questionnaire (including general information, knowledge dimension, attitude dimension and behavior dimension) was used to investigate them.Results:The scores of secondary prevention knowledge, attitude and behavior of 1 087 nurses in Cardiovascular Department were (24.17±5.37) , (53.85±7.97) and (51.23±10.07) , respectively. Multiple linear regression analysis showed that department, whether to have learned relevant guidelines / consensus in the past 12 months, cardiovascular working years, whether to have carried out cardiac rehabilitation in hospital and department, hospital level, whether to have participated in cardiac rehabilitation training were the influencing factors of cardiovascular nurses' knowledge, attitude and practice of secondary prevention management ( P<0.05) . Correlation analysis showed that there were positive correlations among the scores of knowledge, attitude and behavior of secondary prevention of coronary heart disease in nurses of Cardiovascular Department ( P<0.01) . Conclusions:Cardiology nurses need to improve their knowledge and behaviors in the management of secondary prevention of coronary heart disease, while the nursing attitudes are positive. Nursing administrators and educators should strengthen the training and learning of nurses on secondary prevention knowledge of patients with coronary heart disease, so as to effectively improve the compliance of patients with secondary prevention of coronary heart disease self-management.

OBJECTIVE:To evaluate the effectiveness and safety of repaglinide combined with metformin versus glimepiride combined with metformin in the treatment of type 2 diabetes mellitus (T2DM),and to provide evidence-based reference for the clinic. METHODS:Retrieved from CJFD, VIP, Wanfang database, PubMed, Embase, Medline and Cochrane Library, randomized controlled trials (RCTs) about therapeutic efficacy (HbA1c, FPG, 2 hPG) and safety (the incidence of ADR,hypoglycemia and gastrointestinal reaction)of repaglinide combined with metformin(trial group)versus glimepiride combined with metformin(control group)in the treatment of T2DM were collected. Meta-analysis was performed by using Rev Man 5.2 statistical software after data extraction and quality evaluation with Cochrane systematic evaluation manual. RESULTS:A total of 12 RCTs were included,involving 957 patients. Results of Meta-analysis showed that the decrease of 2 hPG in trial group was significantly better than control group,with statistical significance [MD=-0.70,95％CI(-1.02,-0.38),P<0.001]. There was no statistical significance in the decrease of HbA1c [MD=0.00,95％CI(-0.24,0.25),P=0.98] or FPG [MD=0.10,95％CI(-0.17,0.36),P=0.47],the incidence of ADR [OR=0.54,95％CI(0.28,1.06),P=0.07],hypoglycemia [OR=0.52,95％CI(0.13,2.06),P=0.35] or gastrointestinal reactions [OR=0.60,95％CI(0.15,2.41),P=0.47] between 2 groups. CONCLUSIONS:Repaglinide combined with metformin is better than glimepiride combined with metformin in reducing 2 hPG,but both of them have similar safety.

Objective To study the killing effect of cytokine-induced killer cells (CIK cells) on human lung adenocarcinoma cell line (A549) and the lung adenocarcinoma' s radiation resistant cell line (A549RR).Methods Peripheral blood mononuclear cells (PBMC) of healthy volunteers were stimulated by different cytokines,and were induced into killer activity CIK cells.The phenotype of CIK cells were analyzed by flow cytometer.A549 and A549RR cell lines were cultured separately with the CIK cells.The absorbance value (A) of the cells was measured by CCK8,and the killing rates of all cells which were cultured for 24 and 48 hours with the CIK were calculated.Results The rate of CD3+ CD56+ cell was 45.8 ％ after culture for 14 d.The killing rates of CIK cells to lung adenocarcinoma A549 cells and its radiation resistant cells A549RR were increased with the rise of the ratio of effective cells to target (5∶1-40∶1) and the increasing of culturing time (all P ＜ 0.001).The killing effect of CIK to A549 and A549RR cells had no obvious difference in the same culturing time and the same ratio of effective cells to target(all P ＞ 0.05).Conclusion CIK cells have strong anti-tumor effect against lung adenocarcinoma and its radiation resistant cells with high clinical application value.