ObjectiveTo explore the clinical efficacy of Gandou decoction in treating Wilson's disease （WD） with dampness heat accumulation accompanied by rapid eye movement （REM） sleep behavior disorder （RBD）. MethodFrom April 2019 to August 2023，62 patients with dampness heat accumulation type WD accompanied by RBD who met the inclusion criteria were selected from the Department of Encephalopathy at the First Affiliated Hospital of Anhui University of Chinese Medicine. They were randomly divided into a control group and an observation group with 31 cases each using a computer distributor. The control group received routine copper removal treatment，while the observation group received additional treatment with Gandou decoction on the basis of the control group. Eight days was one course of treatment，totaling three courses. The scores of traditional Chinese medicine syndromes，RBD screening questionnaire （RBDSQ） scores，RBD questionnaire-Hong Kong （RBDQ-HK） scores，polysomnography （PSG） parameters，24-hour urine copper （24 h U-Cu） levels，and non-ceruloplasmin-bound copper （NCC） levels between the two groups before and after treatment were compared，and adverse reactions were observed. ResultSixty trial cases were ultimately completed，with 30 cases in each group. Before treatment，there was no statistically significant difference in various indicators between the two groups， and thus they were comparable. Compared with those before treatment，the traditional Chinese medicine syndrome scores，RBDSQ scores and RBDQ-HK scores of the two groups were significantly reduced，the 24 h U-Cu levels were significantly increased，and the NCC levels were significantly reduced （P<0.05，P<0.01）. Compared with the control group， the observation group showed better improvement in traditional Chinese medicine syndrome scores， RBDSQ scores， RBDQ-HK scores， and NCC levels （P<0.05，P<0.01）. Compared with those before treatment，the total sleep time （TST），sleep efficiency （SE），sleep/REM latency，the proportion of N1/N2/REM stages，arousal index （ARI），and proportion of phasic electromyographic activity （P-EMG-A） were significantly improved in both groups （P<0.05）. Compared with the control group after treatment，the observation group showed more significant improvements in the proportion of TST，SE，REM stages，ARI，and P-EMG-A proportion （P<0.05）. ConclusionGandou decoction can not only improve the traditional Chinese medicine syndrome of WD patients with dampness heat accumulation accompanied by RBD but also alleviate their RBD symptoms.

Objective To screen the risk factors and risk prediction model for coronary atherosclerotic heart disease in Xining area. Methods Five hundred and eighteen patients with coronary atherosclerotic heart disease who attended the Qinghai Specialized Hospital for Cardiovascular and Cerebrovascular Diseases and Cerebrovascular Diseases from May 2018 to September 2022 were selected as the observation group, and another 421 patients with non-coronary heart disease were set as control group. The general information of patients were collected. The risk factors affecting the development of coronary heart disease were screened using Logistic regression analysis, and a risk prediction model was constructed, then receiver operating characteristic (ROC) curve was plotted to validate the predictive value of risk model. Results The gender ratio and smoking history yielded no statistical difference between two groups (P>0.05), but statistical difference was found in age, body mass index (BMI), diabetes history, hypertension history, smoking history and family history between two groups (P<0.05). Serum levels of total cholesterol (TC), low-density lipoprotein (LDL) and uric acid (UA) were all higher than the control group, and serum high-density lipoprotein (HDL) level was lower than the control group, with statistical difference (all P<0.05). Multivariate Logistic regression analysis denoted that age, BMI, diabetes history, hypertension history, smoking history, family history, TC, LDL, and UA were risk factors for the development of coronary heart disease (P<0.05). ROC curve analysis yielded an AUC of 0.890 for the risk model, with a sensitivity and specificity of 72.03% and 91.14%, respectively. Conclusion Patient's age, BMI, and the presence of diabetes mellitus, hypertension and smoking, family history, abnormal blood lipid profiles, and abnormal blood uric acid are all risk factors for the development of coronary heart disease, and the risk model constructed on the basis of the above risk factors has a high degree of sensitivity and specificity, which is of great value in accurately evaluating the risk of coronary heart disease.

Objective:Adverse cardiovascular events are the leading cause of death in peritoneal dialysis patients.Identifying indicators that can predict adverse cardiovascular events in these patients is crucial for prognosis.This study aims to assess the value of dual-specificity phosphatase 6(DUSP6)in peripheral blood mononuclear cells as a predictor of adverse cardiovascular events after peritoneal dialysis in diabetic nephropathy patients. Methods:A total of 124 diabetic nephropathy patients underwent peritoneal dialysis treatment at the Department of Nephrology of the First Affiliated Hospital of Hebei North University from June to September 2022 were selected as study subjects.The levels of DUSP6 in peripheral blood mononuclear cells were determined using Western blotting.Patients were categorized into high-level and low-level DUSP6 groups based on the median DUSP6 level.Differences in body mass index,serum albumin,high-sensitivity C-reactive protein,and dialysis duration were compared between the 2 groups.Pearson,Spearman,and multiple linear regression analyses were performed to examine factors related to DUSP6.Patients were followed up to monitor the occurrence of adverse cardiovascular events,and risk factors for adverse cardiovascular events after peritoneal dialysis were analyzed using Kaplan-Meier and Cox regression. Results:By the end of the follow-up,33(26.61%)patients had experienced at least one adverse cardiovascular event.The high-level DUSP6 group had higher body mass index,longer dialysis duration,and higher high-sensitivity C-reactive protein,but lower serum albumin levels compared to the low-level DUSP6 group(all P<0.05).DUSP6 was negatively correlated with serum albumin levels(r=-0.271,P=0.002)and positively correlated with dialysis duration(rs=0.406,P<0.001)and high-sensitivity C-reactive protein(rs=0.367,P<0.001).Multiple linear regression analysis revealed that dialysis duration and high-sensitivity C-reactive protein were independently correlated with DUSP6 levels(both P<0.05).The cumulative incidence of adverse cardiovascular events was higher in the high-level DUSP6 group than in the low-level DUSP6 group(46.67%vs 7.81%,P<0.001).Cox regression analysis indicated that low serum albumin levels(HR=0.836,95%CI 0.778 to 0.899),high high-sensitivity C-reactive protein(HR=1.409,95%CI 1.208 to 1.644),and high DUSP6(HR=6.631,95%CI 2.352 to 18.693)were independent risk factors for adverse cardiovascular events in peritoneal dialysis patients. Conclusion:Dialysis duration and high-sensitivity C-reactive protein are independently associated with DUSP6 levels in peripheral blood mononuclear cells of diabetic nephropathy patients undergoing peritoneal dialysis.High DUSP6 levels indicate a higher risk of adverse cardiovascular events.

Objective To explore the value of bronchial diastolic response (BDR) test in predicting the cough variant asthma (CVA) in patients with chronic cough or negative result of BDR test. Methods A total of 140 patients with chronic cough and negative result of BDR test were selected and treated with inhaled corticosteroids (ICS) and long-acting β2-agonists for 4 weeks, and their lung functions were detected before and after treatment. Receiver operating characteristic (ROC) curve was used to evaluate the predictive values of the forced expiratory volume in the first second as a percentage of predicted value (FEV₁ %), exhaled nitric oxide (FeNO), forced expiratory flow at 25 % to 75 %(FEF_{25 % to 75 %})and forced expiratory flow rate in 25 % to 75 % (FEF %_{25 % to 75 %}) alone or their combined diagnosis. Results After treatment, there were 98 cases diagnosed as negative for CVA and 42 cases diagnosed as positive for CVA. In combination of evaluation indexes, the top three combinations for CVA diagnosis were FEF %_{25 % to 75 %}+△FEV₁ %, FEF_{25 % to 75 %} +FeNO, and △FEV₁ +△FEV₁ %. Venn diagram of the combined prediction showed that there was an overlap in CVA positive diagnostic patients with FeNO ≥ 41.50×10^-9 mol/L, △FEV₁ % ≥ 5.90 %, and FEF %_{25 % to 75 %} ≤ 61.99 %. Conclusion After treatment, patient's showing FeNO ≥ 41.50×10^-9 mol/L, △FEV₁ % ≥ 5.90 % and FEF %_{25 % to 75 %} ≤ 61.99 % can be used to predict CVA and the response to anti-asthma treatment.

Objective:To predict and analyze the number of acute pancreatitis (AP) inpatients based on time series model, and to explore the predictive efficiency of the model.Methods:Clinical data of AP inpatients in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2019 were collected. R software was used to collect the time series of AP inpatients, and the trend and seasonal characteristics of AP inpatients from 2014 to 2018 were analyzed. Furthermore, the autoregressive moving average (ARIMA) model was established through stationarity test, model ordering and model testing steps, and the best selected model was used to predict the monthly number of inpatients in 2019 to verify its prediction efficiency.Results:A total of 3 939 AP patients were included in the study. The most common etiology for AP was cholestrogenic (48.2%), followed by hyperacylglyceremia (36.3%). The peak age of hospitalization was from 40 to 60 years old. Time series analysis showed that the number of AP inpatients increased year by year. The highest peak of the disease was from February to March, followed by September to November; and there was seasonal variation and the incidence was relatively small in summer. The established original training set sequence did not pass the stationarity test ( P=0.061), so the ARIMA model was established after it was transformed into a stationarity sequence by first-order difference. According to the criterion of minimum AIC value, ARIMA(2, 1, 1)(1, 1, 1) 12 was selected as the best model. The model was used to predict the number of AP inpatients in 2019, showing that it could better fit the trend of onset time and had good short-term prediction effect. The mean root error and absolute error were 6.8790 and 4.7783, respectively. Conclusions:The number of AP inpatients increases year by year with seasonal changes. ARIMA model is effective in predicting the number of AP inpatients and can be used for short-term prediction.

【Objective】 To reduce the occurrence of adverse reactions to blood donation during platelet collection in female blood donors with low body weight and high platelet count, so as to improve the comfortableness during platelet collection and increase the proportion of repeated blood donors. 【Methods】 The control group and observation group were compared to explore the causes that may cause adverse reactions in the blood collection cycle using blood collection process program software in MCS⁺, and the incidence of blood donation reaction was compared and observed by increasing the times of oral administrations of calcium gluconate by 10%, increasing the number of collection cycles and reducing the peak plasma volume of the last cycle. 【Results】 After comparing the two groups, it was found that the incidence of adverse reactions in the observation group and the control group was 16.7%(3/18) and 81.2%(26/32), the proportion of repeated donors in the observation group and the control group was 77.7%(14/18) and 31.2%(10/32). 【Conclusion】 Female platelet donors with low body weight and high platelet count should be given more care during the collection process. It is suggested that giving more times of oral administrations of calcium gluconate by 10% and one more collection cycle to reduce the collection peak in each cycle, as well as the supplement of saline, which can effectively reduce the occurrence of adverse reactions to blood donation, thus improving blood donation satisfaction and increasing the proportion of repeated blood donors.

ObjectiveTo observe the clinical efficacy of Gandouling decoction combined with cognitive behavioral therapy （CBT） in the treatment of impulse control disorders in patients with Wilson's disease （WD， syndrome of combined phlegm and stasis）. MethodA prospective study was conducted on 90 WD patients with the syndrome of combined phlegm and stasis and impulse control disorders （ICD） treated in the Department of Encephalopathy of the First Affiliated Hospital of Anhui University of Chinese Medicine from August 2018 to February 2023. They were randomized into a control group， a CBT group， and a treatment group， with 30 patients in each group. The control group received routine Western medicine treatment （basic copper removal）. The CBT group received cognitive behavioral therapy in addition to the therapy in the control group， and the treatment group received Gandouling decoction in addition to the therapy in the CBT group. Each course of treatment was 8 days， and the patients were treated for 4 courses. Before and after treatment， the 24-hour urine copper （24 h U-Cu）， non-ceruloplasmin-bound copper （NCC）， traditional Chinese medicine （TCM） syndrome score， unified WD rating scale part Ⅲ （UWDRS Ⅲ） score， Barratt Impulse Scale Version 11 （BIS-11） score， Buss-Perry aggression questionnaire （BPAQ） score， modified overt aggression scale （MOAS） score， and treatment emergent symptom scale （TESS） score of three groups of patients were determined and statistically analyzed. ResultBefore treatment， there was no statistically significant difference in the level of 24 h U-Cu or NCC among the three groups. After treatment， all the three groups showed an increase in 24 h U-Cu （P<0.01） and a decrease in the NCC level （P<0.05， P<0.01）. There was no significant difference in the 24 h U-Cu level among the three groups after treatment. After treatment， the NCC level showed no significant difference between the control group and the CBT group， while the NCC level in the treatment group was lower than that in the control group and CBT group （P<0.05）. Before treatment， there was no statistically significant difference in the TCM syndrome score among the three groups. After treatment， the TCM syndrome scores of all the three groups decreased （P<0.01）. Moreover， the treatment group had lower TCM syndrome score than the control group and CBT group （P<0.05）. Before treatment， the UWDRS Ⅲ， BIS-11， BPAQ， and MOAS scores had no statistically significant differences among the three groups. After treatment， the UWDRS Ⅲ， BIS-11， BPAQ， and MOAS in all the three groups declined （P<0.05）. Moreover， the CBT group and treatment group had lower UWDRS Ⅲ， BIS-11， BPAQ， and MOAS scores than the control group （P<0.05）， and the treatment group had lower BIS-11 and BPAQ scores than the CBT group （P<0.05）. ConclusionThe combination of Gandouling decoction and CBT can ameliorate impulse control disorders in the WD patients with combined phlegm and stasis.

Irritable bowel syndrome is a gastrointestinal disorder of unknown etiology characterized by widespread, chronic abdominal pain associated with altered bowel movements. Increasing amounts of evidence indicate that injury and inflammation during the neonatal period have long-term effects on tissue structure and function in the adult that may predispose to gastrointestinal diseases. In this study we aimed to investigate how the epigenetic regulation of DNA demethylation of the p2x7r locus guided by the transcription factor GATA binding protein 1 (GATA1) in spinal astrocytes affects chronic visceral pain in adult rats with neonatal colonic inflammation (NCI). The spinal GATA1 targeting to DNA demethylation of p2x7r locus in these rats was assessed by assessing GATA1 function with luciferase assay, chromatin immunoprecipitation, patch clamp, and interference in vitro and in vivo. In addition, a decoy oligodeoxynucleotide was designed and applied to determine the influence of GATA1 on the DNA methylation of a p2x7r CpG island. We showed that NCI caused the induction of GATA1, Ten-eleven translocation 3 (TET3), and purinergic receptors (P2X7Rs) in astrocytes of the spinal dorsal horn, and demonstrated that inhibiting these molecules markedly increased the pain threshold, inhibited the activation of astrocytes, and decreased the spinal sEPSC frequency. NCI also markedly demethylated the p2x7r locus in a manner dependent on the enhancement of both a GATA1-TET3 physical interaction and GATA1 binding at the p2x7r promoter. Importantly, we showed that demethylation of the p2x7r locus (and the attendant increase in P2X7R expression) was reversed upon knockdown of GATA1 or TET3 expression, and demonstrated that a decoy oligodeoxynucleotide that selectively blocked the GATA1 binding site increased the methylation of a CpG island in the p2x7r promoter. These results demonstrate that chronic visceral pain is mediated synergistically by GATA1 and TET3 via a DNA-demethylation mechanism that controls p2x7r transcription in spinal dorsal horn astrocytes, and provide a potential therapeutic strategy by targeting GATA1 and p2x7r locus binding.
Animals ; Astrocytes/metabolism* ; DNA Demethylation ; Epigenesis, Genetic ; GATA1 Transcription Factor/metabolism* ; Inflammation/metabolism* ; Oligodeoxyribonucleotides/metabolism* ; Rats ; Rats, Sprague-Dawley ; Receptors, Purinergic P2X7/metabolism* ; Visceral Pain/metabolism*

Objective To analyze the current status and influencing factors of job competence of clinical nursing teachers. Methods A total of 673 clinical nursing teachers from 35 second-level and above hospitals in Anhui Province were selected as research subjects using convenient sampling method. Their job competence was evaluated using the Clinical Nursing Teacher Post Competency Evaluation Scale. Results The score of job competence of clinical nursing teachers was 87.1±9.7. The results of multiple linear regression analysis showed that with the increase of service length and clinical teaching years，the job competence score of clinical nursing teachers increased（all P<0.05）. For those who thought the higher the satisfaction with the teaching atmosphere of the hospital，the hospital teaching training can meet their requirements and the higher the willingness to accept the teaching training，the higher their job competence score（all P<0.05）. Conclusion There is still much room for improvement in job competence of clinical nursing teachers in Anhui Province. The length of service，clinical teaching years， hospital teaching atmosphere，teaching training meeting demand，and willingness to accept clinical teaching training are the influencing factors of job competence of clinical nursing teachers.

Objective:To evaluate the effect of esketamine on postoperative delirium (POD) in elderly patients undergoing general anesthesia.Methods:Two hundred and twenty-four elderly patients, aged ≥ 65 yr, with American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, undergoing elective surgery under general anesthesia, were divided into 2 groups ( n=112 each) using a random number table method: esketamine group (S group) and control group (C group). Esketamine 0.5 mg/kg was intravenously injected before anesthesia induction in S group, while the equal volume of normal saline was given instead in C group.The Fuzzy Consciousness Assessment Scale (3D-CAM) was used to assess the occurrence of POD within 7 days after surgery.The consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded during operation.The rescue analgesia within 48 h after operation and occurrence of postoperative complications were recorded. Results:Compared with C group, the incidence of POD was significantly decreased, the intraoperative consumption of remifentanil was reduced, and the utilization rate of vasoactive drugs, rate of rescue analgesia and incidence of postoperative vertigo, nausea and vomiting within 48 h after surgery were decreased in S group ( P<0.05). Conclusions:Esketamine can reduce the development of POD in elderly patients.