Objective To explore the changes in early serum calcium,serum phosphorus,and calcium-phosphorus product levels in patients with fractures and analyze their correlation with the fracture site.Methods 1 049 patients with fractures admitted to Sichuan Province Orthopedic Hospital from January 2021 to November 2023 were selected as the research subjects.According to the fracture location,they were roughly divided into two groups:upper body fracture(n=478)and lower body fracture(n=571).Carefully divided into ten groups:vertebral fracture(n=108),clavicle fracture(n=109),upper limb fracture(n=106),hand fracture(n=104),femoral neck fracture(n=103),femoral intertrochanteric fracture(n=106),patella fracture(n=101),lower limb fracture(n=103),foot fracture(n=105)and other fractures(n=104).Another 110 cases of healthy physical examination people during the same period were selected as the control group.Venous blood was drawn from all patients twice on the day of emergency within 24 to 48 hours after admission,serum calcium and serum phosphorus were measured,and the calcium-phosphorus product was calculated.Compare the changes in the levels of the three and analyzed their correlation with the fracture site.Results Compared with the control group,the serum calcium(2.27±0.12 mmol/L,2.19±0.12 mmol/L vs 2.35±0.10mmol/L),serum phosphorus(1.00±0.20mmol/L,1.08±0.19mmol/L vs 1.15±0.15mmol/L),and calcium-phosphorus product(28.10±6.00mg/dl,29.30±5.85mg/dl vs 33.41±4.87mg/dl)of fracture patients were all reduced on the day of emergency and 24 to 48 hours after admission,and the differences were statistically significant(t=6.804,12.501;7.475,3.722;8.964,7.115,all P＜0.01).Comparing upper and lower body fractures,serum calcium,serum phosphorus,and calcium-phosphorus product on the emergency day was lower in lower body fracture than in upper body fracture(t=4.129,5.931,6.660,all P＜0.01),24 to 48 hours after admission,only the serum calcium and calcium-phosphorus product were lower in lower body fracture than in upper body fracture(t=6.432,1.990,all P＜0.05),and the differences were statistically significant,respectively.Comparing along the time axis,24 to 48 hours after admission compared with the emergency day,both upper and lower body fractures showed a decrease in serum calcium and an increase in serum phosphorus(t=12.779,-5.730;16.919,-14.358),calcium-phosphorus product only increased in lower body fracture(t=-8.860),and the differences were statistically significant(all P＜0.01),respectively.Compared with the day of emergency,24 to 48 hours after admission for patients with fractures in different parts,except for vertebral fracture,serum calcium in the other nine groups decreased(t=6.233～11.349,all P＜0.01),except for upper limb fracture and hand fracture,the serum phosphorus in the other eight groups increased(t=-7.770～-3.327,all P＜0.01),the calcium-phosphorus product of vertebral fracture,femoral neck fracture,femoral intertrochanteric fracture,lower limb fracture,foot fracture,and other fractures increased(t=-5.819～-2.927,all P＜0.01),and the differences were statistically significant,respectively.Conclusion The serum calcium,serum phosphorus,and calcium-phosphorus product of patients with fractures all decreased on the day of emergency.24 to 48 hours later,the serum calcium of most patients continued to decrease while the serum phosphorus and calcium-phosphorus product gradually increased.The degree of change in their levels was related to the fracture site.

Objective To develop an expert consensus on subcutaneous injection nursing for allergic asthma in children,standardize nursing practice to reduce the occurrence of related adverse reactions.Methods The clinical guideline,expert consensus,systematic review,evidence summary and original research on subcutaneous injection of monoclonal antibody drug for children with allergic asthma were comprehensively searched in domestic and foreign databases.The time limit for retrieval was from the establishment of databases until August 2023.Combined with clinical practice experience,the first draft of the consensus was formed.From December 2023 to February 2024,27 experts were invited to conduct 2 rounds of expert letter consultation,revise and improve the contents of the first draft,and expert demonstration was conducted,and finally a consensus final draft was formed.Results The effective recovery rate of the 2 rounds of letter consultation questionnaires was 100％;the authority coefficient of experts was 0.88;the judging basis coefficient was 0.93;the familiarity coefficient was 0.83.In the 2 rounds of correspondence,the Kendall concordant coefficients of expert opinions were 0.241 and 0.252,respectively(P＜0.001 for both).The consensus includes 6 parts,including personnel management,environmental layout,indications and contraindications,subcutaneous injection operation norms,identification and treatment of adverse reactions,and health education.Conclusion The consensus is strongly scientific and practical,and can provide guidance for nursing practice of subcutaneous injection of monoclonal antibodies in children with allergic asthma.

Objective To explore the correlation between left atrial diameter (LAD) and renal function in patients with atrial fibrillation. Methods A total of 364 patients with atrial fibrillation were selected as study subjects. Clinical data of the patients were collected, including gender, age, height, body weight, smoking history, drinking history, atrial fibrillation type, history of hypertension, coronary heart disease, diabetes, heart failure, medication history, high-sensitivity troponin I, brain natriuretic peptide, C-reactive protein, creatinine, urea nitrogen, LAD, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd), left ventricular posterior wall thickness (LVPWTd), and interventricular septal thickness (IVSTd). Estimated glomerular filtration rate (eGFR) and body mass index were calculated. Spearman correlation analysis was used to explore the correlations of LAD with creatinine, urea nitrogen, and eGFR. With eGFR < 60 mL/(min·1.73 m²) setting as renal insufficiency, univariate Logistic regression analysis was used to explore the influencing factors of renal insufficiency in patients with atrial fibrillation. Binary Logistic regression analysis was used to explore the relationship between LAD and renal insufficiency in patients with atrial fibrillation. Results Spearman correlation analysis showed that LAD was positively correlated with creatinine (r=0.279, P < 0.001) and urea nitrogen (r=0.190, P < 0.001) in patients with atrial fibrillation, and negatively correlated with eGFR (r=-0.263, P < 0.001). Univariate Logistic regression analysis showed that gender, history of diabetes, hypertension, coronary heart disease, heart failure, atrial fibrillation type, sodium-glucose cotransporter 2 inhibitor medication history, diuretic medication history, LAD, LVEF, LVDd, and IVSTd were all influencing factors of renal insufficiency in patients with atrial fibrillation (P < 0.05). Binary Logistic regression analysis showed that compared with the first quartile of LAD (LAD ≤ 38 mm), the risk of renal insufficiency in patients with atrial fibrillation in the fourth quartile of LAD (LAD>47 mm) increased by 5.199 times(OR=5.199; 95 %CI, 1.210 to 22.337; P=0.027). Conclusion LAD of patients with atrial fibrillation is significantly related to renal function, and LAD is an influencing factor of renal insufficiency in patients with atrial fibrillation.

Objective To investigate the correlation between serum asprosin level and atrial fibrillation. Methods A total of 85 hospitalized patients with atrial fibrillation in the Department of Cardiology of Qingdao Municipal Hospital from October 2021 to October 2023 were selected as atrial fibrillation group, and 86 hospitalized patients with normal sinus rhythm in the same period were selected as non-atrial fibrillation group. Clinical materials and serum asprosin level of patients were collected and compared. Logistic regression analysis was performed to establish a linear stepwise regression model based on potential confounding factors for exploration in the independent risk factors for atrial fibrillation. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of asprosin for atrial fibrillation. Results Serum asprosin level in the atrial fibrillation group, was significantly higher than that in the non-atrial fibrillation group (P < 0.001). The linear stepwise regression model showed that asprosin was an independent risk factor for atrial fibrillation (OR=1.020, 95%CI, 1.005 to 1.036, P=0.01). The ROC curve showed that the area under the curve of serum asprosin in predicting atrial fibrillation was 0.745 (95%CI, 0.670 to 0.819). Conclusions Serum asprosin level is significantly elevated in patients with atrial fibrillation, and asprosin is an independent risk factor for atrial fibrillation. Serum asprosin level has good diagnostic value for atrial fibrillation.

PRECEDE-PROCEED model is a new research hotspot in the field of health education in recent years, which has been widely used in many education fields and has achieved good results. This article discussed in detail the theoretical framework, advantages and application status of PRECEDE-PROCEED model in the field of health education, so as to enhance the medical and nursing staff's understanding of this model, and provide a reference for applying this model to clinical work scientifically.

Objective To analyze the clinical efficacy of balloon occlusion of distal abdominal aorta for patients with pernicious placenta previa and placenta accreta.Methods Data of 72 patients with pernicious placenta previa and placenta accreta were retrospectively analyzed.There were 53 cases (occlusion group) reserved balloon occlusion in abdominal aorta before cesarean section,which can temporarily blocked abdominal aortic blood flow during operation.The other 19 cases (non-occlusion group) underwent cesarean section without balloon occlusion of abdominal aorta.The intraoperative,post operative situations and the birth state of newborn of the two groups were compared.Results The bleeding,blood transfusion and hysterectomy rate during the operation in occlusion group were less than those in non-occlusion group (all P＜ 0.05).Differences of the rate of postoperative transferring to intensive care unit (ICU) and the time in ICU were statistically significant between two groups (both P ＜0.05).No statistical difference of operation time,postoperative total hospital stay time and the rate of postoperative infection was found between two groups (both P＞0.05).There was no statistical difference of newborns weight and Apgar scores (5 min and 10 min after birth) between two groups (all P＞0.05).Conclusion The balloon occlusion of distal abdominal aorta in cesarean section for patients with pernicious placenta previa and placenta accreta is safe and feasible,which can effectively reduce the intraoperative bleeding,the blood transfusion and the risk of hysterectomy.

Objective To analyze the prevalence and clinical features of cytomegalovirus (CMV)infection in patients with systemic lupus erythematosus (SLE).Methods Patients with SLE in Peking University Third Hospital from 2013 to 2015 and age and sex matched healthy controls were enrolled.All patients were detected for CMV antibody,CMV DNA and CMV PP65 in the blood.The prevalence of CMV infection and the clinical characteristics were analyzed using Chi-square test.Results Altogether 349 SLE patients and 209 healthy controls were enrolled.In SLE group,the positive rate of CMV IgG was 90.3％ (315/349),which was similar to that of the control group,while the positive rate of CMV IgM was 8.0％ (28/349),which wassignificantly higher than controls 1.4％(3/209) (x2=10.811,P=0.001),and the active CMV infection rate was 69.1％(241/349).Those in the active phase of SLE were more likely to have active CMV infection when compared with those in remission [75.4％(93/256) vs 51.6％(48/93),x2=18.049,P＜0.01].The percentage [43.2％(104/241)] of severe patients in those with active CMV infection was much higher than that in those without CMV infection 9.2％(10/108) (x2=38.953,P＜0.01).Those SLE patients had active CMV infection were clinically more severe and the most common clinical manifestation were proteinuria/hemoturia,cytopenia and fever.Conclusion In SLE patients,the positive rate of CMV IgM is significantly higher than healthy control and the prevalence of active CMV infection is high,especially in those at active disease.Those with active CMV infection are clinically more severe but have no features of active CMV infection,which indicates that the CMV infection might be a trigger of SLE activity.

Objective To study the effects of salt and cooking oil intervention among hypertensive patients on knowledge-attitude-practice. Method Three thousand hypertensive patients from 20 community health service centers in Shenzhen were chosen by multi-stage cluster random sampling method. Salt measuring spoons and scaled oil pots were provided during six-month health intervention. Before and after the six-months health intervention, 2 976 and 2 864 valid questionnaires were collected respectively. After intervention, 40 families were randomly selected to perform an investigation of cooking oil and salt weighing during 3 d 24 h. Result Before the intervention, the rates of awareness on the intake of salt and cooking oil were 29.94% and 16.23% respectively. After intervention, the rates increased to 88.58% (P<0.000 1) and 84.29%(P<0.000 1) respectively. The rates of restriction on the intake of salt and cooking oil were 62.97% and 59.07%, respectively, after the intervention, the rates were 97.14% and 96.79% (P<0.000 1), respectively. By using the salt measuring spoons and scaled oil pots, the intake of cooking oil and salt reached the recommended amount in Chinese dietary guideline. Conclusion The implementation of health education combined with appropriate tools could promote the knowledge and behavior of the salt and cooking oil consumption.

Objective To investigate the relationship of HSP27 expression with treatment response ,remission rate ,prognosis in multiple myeloma(MM) patients .Methods Eighty‐six patients with MM first diagnosis and 27 relapse cases were collected re‐spectively .Control was defined as non‐hematological malignance .The MM patients divided into first diagnosis ,relapse conventional chemotherapy group and bortezomib group .HSP27 expression and protein level were measured on pre‐and post 1 ,2 and 3 treatment circles .Results The tendency of HSP expression and protein level:relapse‐MM patients> first‐diagnosis MM patients> control . HSP27 expression and level in Ⅲ phase was higher than those in Ⅱ phase for first‐diagnosis MM patients .Bortizomib‐containing chemotherapy protocol showed more effectively decrease on HSP27 than chemotherapy treatment only .At post‐1 treatment circle , HSP27<1 showed higher survival rate than HSP27>1 and delayed the relapse time .Conclusion BMMNC‐HSP27 expression and protein level is associated with staging ,treatment response and prognosis in MM patients .

Objective To explore the effect of quality control circle ( QCC ) on non-standard implementation of aseptic operation related medical staffs. Methods Through QCC activities, a total of 950 operation related medical staffs had been investigated non-standard implementation status of aseptic operation, and analyzed the causes, made out and carried out its countermeasures. Results Non-standard implementation of aseptic operation declined from 690 person-time to 175 person-time, and the target completion rate was 105%, improvement rate 75%, of which spreading towels did not reached standard declined from 327 person-time to 99 person-time. The off operation table people, who was too near from the sterile stage, declined from 134 person-time to 33 person-time, while not using the non-contact wear gloves declined from 71 person-time to 12 person-time. Conclusions QCC activities can significantly reduce the person-time of non-standard implementation of aseptic operation and effectively improve the quality of work.