Objective: To explore the clinical features, treatment and prognosis of emphysematous pyelonephritis (EPN), so as to enhance the clinical awareness of this disease. Methods: A retrospective analysis was conducted on the clinical data of one EPN patient at The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, and a literature review was performed on articles published in the China National Knowledge Infrastructure and PubMed databases from Jan.1, 2015 to Dec.31, 2024. Results: The patient, a 62-year-old male with a 5 years' history of type 2 diabetes, was admitted due to left flank pain for 4 days, with a temperature of 39.4 ℃.Laboratory tests indicated significantly elevated inflammatory markers, decreased platelet count, and abnormal coagulation function.Preoperative blood and urine cultures showed positivity for Escherichia coli.Computed tomography (CT) revealed complete erosion of the left kidney, with gas in the left ureter and surrounding effusion, as well as multiple free gas in the abdominal cavity, bilateral ureteral stones, right renal lower calyx stones.After a multidisciplinary consultation, he underwent emergency phase Ⅰ left pyeloplasty and perirenal drainage with ureteral stenting.After discharge, the patient received maintenance hemodialysis once every two days in the outpatient clinic.One week after-discharge, the patient was readmitted due to polypnea.Following symptomatic management, vital signs stabilized.Approximately 2 months after the first-stage surgery, ureteroscopic stone extraction was successfully performed.One month after the stone extraction procedure, a follow-up CT showed normalization of the left kidney, renal pelvis and calyces, leading to phase Ⅱ laparoscopic left nephrectomy via the abdominal approach, with postoperative pathology indicating renal necrosis.Among 89 EPN patients reported in 35 articles, the median age was 58(24-92) years old；there were 59（66.3%） females and 30（33.7%） males；fever was the most common clinical symptom (60.7%)；73(82.0%) had diabetes, 12 (13.5%) had urinary tract obstruction；55 (61.8%) were infected with Escherichia coli, and 7 (7.9%) were infected with Klebsiella pneumoniae; 13 died due to ineffective treatmen. Conclusion: EPN presents acutely and progresses rapidly, often leading to misdiagnosis due to the lack of specific early symptoms.Abdominal CT is the preferred imaging modality for rapid diagnosis, and proactive interdisciplinary intervention can improve survival rates, reduce the need for nephrectomy, and enhance prognosis.

Objective:To investigate the current situation and related factors of children's growth and development in drinking-water-borne endemic fluorosis areas after water improvement, and provide a basis for improving the control strategies.Methods:The stratified random sampling method was used to select children aged 7 to 13 in villages with different years of water improvement in Xi'an from November 2019 to June 2020. The height and weight of children were measured, and body mass index (BMI) was calculated. The height development level of children was graded according to the "Standard for Height Level Classification among Children and Adolescents Aged 7 - 18 Years" (WS/T 612-2018), and the physical development (BMI) level of children was determined according to the "Comprehensive Evaluation of Development Level for Children and Adolescents" (GB/T 31178-2014). At the same time, according to the standard of "Diagnosis of Dental Fluorosis" (WS/T 208-2011), the diagnosis of dental fluorosis in children was performed. The serum fluoride level was determined by ion selective electrode method, and the levels of other chemical elements (calcium, iron, magnesium, copper, zinc, iodine, selenium, lead, arsenic, cadmium, chromium, mercury, nickel) in blood were determined by inductively coupled plasma mass spectrometry.Results:A total of 469 children were included in the investigation. After water improvement, 67.38% (316/469) of the children in the disease area were at the moderate level of height development, 7.89% (37/469) were at the medium to upper and upper levels, and 24.73% (116/469) were at the medium to lower and lower levels. The BMI of the children in the emaciation group was 8.53% (40/469), while it was 10.87% (51/469) in the overweight group and 8.74% (41/469) in the obesity group. There was statistically significant difference in the distribution of height development level of children in areas with different water improvement years ( P = 0.005), but no statistically significant difference in BMI distribution ( P = 0.154). There was no significant difference in height development level and BMI distribution of children with or without dental fluorosis ( P > 0.05). There were significant differences in serum levels of iron and zinc among children with different height development levels ( P < 0.05). There were significant differences in serum levels of magnesium, copper, iodine and chromium among children with different BMI ( P < 0.05). Conclusion:The growth and development of children in drinking-water-borne endemic fluorosis area after water improvement are not correlated with the prevalence of dental fluorosis, but may be related to the levels of chemical elements such as iron, magnesium, copper, and iodine in the body.

Objective:To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China.Methods:The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia.Results:The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% ( HR=1.22, 95% CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% ( HR=0.67, 95% CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion:Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.

Objective To analyze the current status of dyslipidemia among employees in a petrochemical enterprise and its influencing factors. Methods A total of 1 636 employees from a petrochemical enterprise were selected as the research subjects by the judgment sampling method. Peripheral venous blood was collected from the research subjects to detect total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low- density lipoprotein cholesterol (LDL-C) in serum. The Effort-Reward Imbalance (ERI) Questionnaire was used to investigate occupational stress in the ERI model. Results The detection rate of dyslipidemia among the research subjects was 52.7%. The detection rates of abnormal total cholesterol, triglyceride, LDL-C, and HDL-C were 35.7%, 31.4%, 24.3%, and 10.0%, respectively. The detection rate of high occupational stress among the research subjects was 26.3%. The result of multivariate logistic regression analysis showed that the risks of dyslipidemia in overweight and obese employees were higher than that of normal body mass [ odds ratio (OR) and 95% confidence interval (CI) were 2.111 (1.692-2.634) and 2.346 (1.591-3.458), both P<0.01]. The risk of dyslipidemia in lean body mass employees was lower than those with normal body mass [OR (95%CI) was 0.130 (0.030-0.564), P<0.05]. The risk of dyslipidemia in smokers was higher than that in non-smokers [OR (95%CI) was 1.462 (1.124-1.902), P<0.01]. Employees with 20-30 years and ≥ 30 years of service had higher risks of dyslipidemia than those with <10 years of service [OR (95%CI) were 1.411 (1.038-1.919) and 1.869 (1.202-2.906), respectively, both P<0.05]. The risk of dyslipidemia among employees with high effort level of occupational stress in ERI model was higher than those with low effort level [OR (95%CI) was 1.351(1.045-1.745), P<0.05]. Conclusion Dyslipidemia prevalence is relatively high among the petrochemical enterprise employees. Overweight, obesity, smoking, long service years, and occupational stress in ERI model are influencing factors of dyslipidemia. To prevent dyslipidemia, it is necessary to strengthen blood lipid monitoring and lifestyle intervention in personnel with overweight, obesity, smoking, long service years, and occupational stress in ERI model.

Objective:To develop a list of basic and expanded medical laboratory tests in community health service centers in Shanghai.Methods:The status quo of human and equipment resource allocation, the test items and quality control currently performed, the perspectives of various stakeholders, the capacity building of community clinical laboratory in community health service centers in Shanghai were investigated by quantitative survey and qualitative interview; and the rating scores of each test item were assessed by expert consultation using Delphi method. The expert focus discussion was conducted, and each test item was rated and classified. Finally a list of the basic tests and expanded tests in clinical laboratories of community health service center was developed.Results:A total of 247 questionnaires were distributed and 192 (77.7%) were answered. A list of 94 laboratory test items was screened out based on the questionnaire survey of the laboratories of the community health centers. Thirty one experts in the relevant areas were invited to rate the test items, the average authority coefficient of experts was 0.90, with which the weighted average of the expert ratings was made. There were 45 (47.9%) items scored 7 or higher, 38 (40.4%) scored between 5 and 7, and 11 (11.7%) scored less than 5. Based on the results of the expert focus discussion, 48 items were recommended as the basic tests and 46 items as the extended tests.Conclusion:In this study a list of tests recommended to clinical laboratories in Shanghai community health service centers has been developed, which contains 48 basic tests and 46 extended tests.

Scaffold hopping refers to computer-aided screening for active compounds with different structures against the same receptor to enrich privileged scaffolds, which is a topic of high interest in organic and medicinal chemistry. However, most approaches cannot efficiently predict the potency level of candidates after scaffold hopping. Herein, we identified potent PDE5 inhibitors with a novel scaffold via a free energy perturbation (FEP)-guided scaffold-hopping strategy, and FEP shows great advantages to precisely predict the theoretical binding potencies ΔG _FEP between ligands and their target, which were more consistent with the experimental binding potencies ΔG _EXP (the mean absolute deviations | Δ G FEP - Δ G EXP |  < 2 kcal/mol) than those ΔG _MM-PBSA or ΔG _MM-GBSA predicted by the MM-PBSA or MM-GBSA method. Lead L12 had an IC₅₀ of 8.7 nmol/L and exhibited a different binding pattern in its crystal structure with PDE5 from the famous starting drug tadalafil. Our work provides the first report via the FEP-guided scaffold hopping strategy for potent inhibitor discovery with a novel scaffold, implying that it will have a variety of future applications in rational molecular design and drug discovery.

Objective:To observe the therapeutic timing and dosage of intravenous immunoglobulin (IVIG) in children with severe adenovirus pneumonia.Methods:Clinical data of children with severe adenovirus pneumonia treated with IVIG at the Department of Respiratory, Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from January 2019 to January 2020 were retrospectively analyzed.Participants were classified as early presenters (5-10 days of illness course) and later presenters (11-15 days of illness course) according to the timing of IVIG treatment.They were further subdivided into plan 1 group[1 g/(kg·d) IVIG for 2 days] and plan 2 group [0.4-0.5 g/(kg·d) IVIG for 3-5 days]. Continuous variables and categorical variables between groups were analyzed by the nonparametric Mann- Whitney U test and the Fisher′ s exact test, respectively. Results:A total of 202 patients with the median age of 12 (12, 36) months were recruited, involving 128 early presenters (63.37%) and 74 later presen-ters (36.63%). Later presenters had a longer duration of fever [18.00(14.00, 23.25) days vs.11.00(9.00, 14.00) days], more demands for mechanical ventilation (33.78% vs.20.31%), and higher incidence of bronchiectasis (9.46% vs.1.56%) than those of early presenters (all P<0.05). For early presenters, no significant differences were detected in the demand for advanced life support, outcomes and sequelae between plan 1 group and plan 2 group (all P>0.05). For later presenters, a shorter duration of fever [18.00(14.00, 21.00) days vs.21.00(15.50, 30.75) days] and lower usage of extracorporeal membrane oxygenation (ECMO, 2.13% vs.18.52%) were observed in the plan 1 group than that of plan 2 group (all P<0.05). The incidence of post-infectious bronchiolitis obliterans and bronchiectasis as pulmonary sequelae was comparable between plan 1 group and plan 2 group ( P>0.05). The incidence of adverse events was 5.77% during IVIG infusion, showing no significant difference between plan 1 group and plan 2 group ( P>0.05). Conclusions:Early treatment of IVIG are very important to improve the prognosis of children with severe adenovirus pneumonia.For later presenters, a high dosage of IVIG is effective in reducing the ECMO use and shortening the duration of fever, thus providing clinical benefits.

Objective To explore the effect of continuous nursing intervention on limb function and nursing quality after proximal femoral nail antirotation (PFNA) internal fixation for femoral intertrochanteric fracture in the elderly. Methods From February, 2017 to November, 2018, 100 elderly patients with femoral intertrochanteric fracture who underwent PFNA internal fixation in our hospital were randomly divided into control group (n = 50) and observation group (n = 50), who accepted routine nursing and continuous nursing respectively for three months. They were assessed with Harris score and visual analogue scale for pain (VAS) before and after the intervention. The postoperative nursing effect was compared. Results The Harris score increased in both groups after the intervention (t > 45.98, P < 0.001), and increased more in the observation group than in the control group (t = 15.03, P < 0.001). The VAS score decreased in both groups after the intervention (t > 16.33, P < 0.001), and decreased more in the observation group than in the control group (t = 9.749, P < 0.001). The effect of nursing was better in the observation group than in the control group (Z = -2.272, P = 0.023). Conclusion Continuous nursing intervention can significantly improve the limb function and nursing satisfaction of elderly patients with femoral intertrochanteric fracture after PFNA.

Objective : To observe the effect of hydrogen sulfide( H2 S) on the expression of transforming growth factor⁃β1(TGF⁃ β1) , E ⁃cadherin (E⁃CAD) , Vimentin (VIM) , alpha⁃smooth muscle actin ( α ⁃SMA) during epithelial⁃mesenchymal transformation(EMT) , and to explore the anti⁃fibrosis mechanism of it. Methods : Sixty rats ( male SD) were randomly divided into control group, bleomycin group, NaHS + bleomycin group and prednisolone + bleomycin group , 15 rats per group. 5 rats of each group were sacrificed at random in 7th , 14th and 28th day. The degree of alveolitis and pulmonary fibrosis was observed . The expression of protein and mRNA of TGF⁃ β1 , E ⁃cad , VIM , α ⁃SMA were determined by Immunohistochemi stry and RT⁃PCR. Results : ① HE and Masson staining showed that the lung tissue of fibrosis had the lowest degree in control group. and the most severe in bleomycin group. The lung tissue of NaHS + bleomycin group and prednisolone + bleomycin group also had alveolitis and fibrosis changes , but the degree Were significantly less than bleomycin group. ② The mRNA and protein expression levels of TGF⁃ β1 , VIM and α ⁃SMA in bleomycin group, NaHS + bleomycin group and prednisolone + bleomycin group were all higher than that in control group at 7th , 14th and 28th day ( P < 0. 05 ) , while the expression levels of them in NaHS + bleomycin group and prednisolone + bleomycin group were all lower than that in bleomycin groupat each time (P < 0. 05) , which was significant at 28th day in NaHS + bleomycin. ③ The mRNA and protein expression levels of E ⁃Cad in bleomycin group, NaHS + bleomycin group and prednisolone + bleomycin group were all lower than that in control group at 7th , 14th and 28th day(P < 0. 05) , but the expression levels of E ⁃Cad in⁃NaHS + bleomycin group and prednisolone + bleomycin group were higher than that in bleomycin group at each time(P < 0. 05) , which was significant at 28th day in NaHS + bleomycin. Conclusion H2 S can reduce the degree of pulmonary fibrosis in rats , its mechanism may be related to the down⁃regulation of TGF⁃ β1and the inhibition of the EMT , which can enhance the expression of E ⁃cad and reduce the expression of TGF⁃ β1 , VIM and α ⁃SMA.

Objective:To evaluate and summarize evidence related to structured skin care for incontinence-associated dermatitis (IAD) in adult inpatients, so as to provide a reference for clinical nursing decision-making.Methods:Clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus related to structured skin care for IAD in adult inpatients were retrieved by computer in British Medical Journal Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Health Care Centre in Australia, Canadian Registered Nurses Association of Ontario, Guidelines International Network, National Guideline Centre, National Institute for Health and Care Excellence, Medlive, the Cochrane Library, PubMed, Web of Science, CINAHL, Embase, WanFang Data, VIP, China National Knowledge Infrastructure, China Biomedical Literature Database. The retrieval time limit was from the establishment of the database to April 30, 2021. Two investigators independently assessed the quality of the included evidence and the level of recommendation.Results:A total of 14 articles were included, involving 2 clinical decisions, 1 practice guideline, 6 evidence summaries, 2 systematic reviews, and 3 expert consensus. A total of 29 best evidence was compiled from 4 aspects of structured skin care assessment, cleansing, moisturizing and isolation.Conclusions:Medical and nursing staff should integrate evidence with clinical scenarios and patient preferences to make optimal clinical decisions on structured skin care and improve the quality of care for adult inpatients with IAD.