[Objective] To analyse and predict the tendencies of using erythrocyte blood in Changsha based on the autoregressive integrated moving average (ARIMA) model, long short-term memory (LSTM) and ARIMA-LSTM combination model, so as to provide reliable basis for designing a feasible and effective blood inventory management strategy. [Methods] The data of erythrocyte usage from hospitals in Changsha between January 2012 and December 2023 were collected, and ARIMA model, LSTM model and ARIMA-LSTM combination model were established. The actual erythrocyte consumption from January to May 2024 were used to assess and verify the prediction effect of the models. The extrapolation prediction accuracy of the models were tested using two evaluation indicators: mean absolute percentage error (MAPE) and root mean square error (RMSE), and then the prediction performance of the model was compared. [Results] The RMSE of LSTM model, optimal model ARIMA(1,1,1)(1,1,1)12 and ARIMA-LSTM combination model were respectively 5 206.66, 3 096.43 and 2 745.75, and the MAPE were 18.78%,11.54% and 9.76% respectively, which indicated that the ARIMA-LSTM combination model was more accurate than the ARIMA model and LSTM model, and the prediction results was basically consistent with the actual situation. [Conclusion] The ARIMA-LSTM model can better predict the clinical erythrocyte consumption in Changsha in the short term.

Objective:To summarize the first aid and nursing experience of a patient with upper gastrointestinal bleeding induced by Dieulafoy disease after liver transplantation.Methods:One case with upper gastrointestinal bleeding induced by Dieulafoy disease after liver transplantation was given a series of treatment and nursing measures, including identify bleeding manifestations, providing emergency nursing measures, nutritional support treatment, establishing infection prevention and control system, implementing prone ventilation and pulmonary function rehabilitation, precise immunosuppressive therapy, various forms of psychological care in the First Hospital of Jilin University in November 22, 2021.Results:After 58 d of careful treatment and nursing, the patient recovered and was discharged.Conclusions:Dieulafoy disease is a critical disease, and early diagnosis and targeted first aid and predictive care for liver transplant patients with such diseases are the key to promoting recovery.

Objective:To investigate the epidemic distribution and characteristics of brucellosis in Heze City, and to provide a basis for formulating prevention and control measures in the future.Methods:The data of Heze City brucellosis reported from January 1, 2017 to December 31, 2021, were collected from the China Disease Prevention and Control Information System. The epidemiological case questionnaires of brucellosis in Heze City from January 1, 2017 to December 31, 2021 were collected from the centers for disease control and prevention of various cities, counties and districts. Retrospective analysis was used to conduct a descriptive analysis of the distributions, clinical manifestations and epidemiological history 3 weeks prior to the onset of the disease in Heze City from 2017 to 2021.Results:From 2017 to 2021, a total of 1 543 cases of brucellosis were reported in Heze City, with no death. The highest incidence was in 2018 (5.16/100 000). The peak period was from March to June each year (759 cases). There were cases reported in all counties (districts) of the city, and the counties (districts) with more cases were Mudan District (386 cases), Cao County (271 cases), Yuncheng County (251 cases), Shan County (138 cases) and Juye County (132 cases). The minimum age of onset was 11 months, and the maximum was 84 years old, mainly between the ages of 20 to 69 (1 381 cases). The gender ratio between males and females was 2.50 ∶ 1.00 (1 102 ∶ 441). Farmers had the highest incidence of the disease (1 329 cases). Main clinical manifestations were fever, hyperhidrosis, fatigue, muscle and joint soreness. Epidemiological history investigation within 3 weeks before the onset of the disease revealed 1 124 cases of close contact with animals, including 1 044 cases of contact with sheep.Conclusions:From 2017 to 2021, the incidence of brucellosis in Heze City shows a trend of first rising and then decreasing, and the epidemic affects all counties (districts) of the city, mainly middle-aged and elderly men. In the future, it is necessary to strictly control the flow of diseased animals, increase immunization and quarantine, and block the transmission route.

Background and purpose:Rectal cancer is one of the malignant tumors that seriously harm human health in the world,ranking third in incidence and second in mortality.With the development of social and economic level,the incidence and mortality of colorectal cancer in China are increasing,and China becomes one of the countries with high incidence of colorectal cancer disease in the world.The recommended treatment for locally advanced rectal cancer is neoadjuvant chemoradiotherapy combined with surgery,which greatly improves the prognosis of patients.However,intestinal adverse reactions such as diarrhea caused by neoadjuvant chemoradiotherapy are increased,and some patients are forced to delay or interrupt treatment due to serious side effects.Amifostine is a broad-spectrum normal cell protective agent,which has good protective effect against various radiochemotherapy toxicity.We conducted a retrospective analysis of patients with locally advanced rectal cancer who received neoadjuvant radiotherapy combined with irinotecan concurrent chemotherapy to investigate whether concurrent use of amifostine alleviated gastrointestinal and hematological toxicities.Methods:A retrospective cohort analysis was used in this study.Clinical data of patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy at the Affiliated Cancer Hospital of Fudan University during the period of discharge from January 1,2018 to December 31,2019 were retrospectively collected.The patients were divided into 2 groups by whether amifostine was used during the same period.The main purpose of the study was to analyze whether amifostine can reduce gastrointestinal and hematological toxicities,and secondary objectives included whether amifostine could alter tumor marker levels,mesorectal fascia invasion(MRF)positive rate,extramural vascular invasion,positive rate of EMVI and pathological complete response(pCR).Using SAS9.4 statistical software,the normality test was carried out for continuous variables.The rank sum test of Wilcoxon was performed when the diarrhea grade did not conform to normal distribution.Analysis of variance was performed for intra-group comparison,and Wilcoxon rank sum test was performed for inter-group comparison.Because of the imbalance between groups,the difference between the two groups was compared using a generalized linear model.This study strictly followed the STrengthening the Reporting of OBservational studies in Epidemiology(STROBE)guidelines to ensure the transparency of the research methodology and the reliability of the results.Results:Finally,154 eligible patients were included,of whom 78 were in the amifostine group and 76 were in the control group.The highest grade of diarrhea in amifostine group was 1.00(1.00,1.00),lower than that in control group(2.00,3.00),and the difference between groups was statistically significant(P＜0.01).After radiotherapy,white blood cell count(WBC),hemoglobin(HB)and absolute neutrophil count(ANC)from the two groups were obtained.ANC and platelet count(PLT)showed no statistically significant difference(P＞0.05),and the lowest values of WBC,RBC and PLT did not have statistically significant difference between the two groups during neoadjuvant period(P＞0.05).Amifostine may not alleviate hematological toxicity.Carbohydrate antigen 72-4(CA72-4)(Z=2.22,P=0.03),carbohydrate antigen 50(CA50)(Z=-2.49,P=0.01)and carbohydrate antigen 24-2(CA24-2)had statistically significant difference(Z=-2.29,P=0.02).There were no significant differences in MRF positive rate(P=0.11),EMVI positive rate(P=0.61)and pCR rate(P=0.94)between the two groups.Conclusion:Concurrent administration of amifostine in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy can reduce gastrointestinal toxicity and reduce the levels of tumor markers CA72-4,CA50 and CA24-2.However,it may have no significant effect on improving hematological toxicity,MRF and EMVI positive rate and pCR rate.

Objective:To establish an inductively coupled plasma-mass spectrometry(ICP-MS)method for the determination of 24 elements in polysorbate 80,and evaluate the results.Methods:The elements were determined by ICP-MS,statistical analysis was conducted using SPSS 26,and the risk assessment was carried out with reference to ICH Q3D guidelines.Results:The standard curves showed good linear relationship in the corresponding concentration range(r=0.997-0.999).The recoveries were 88.81％-134.64％(RSD＜5％,n=6).None of the elements recommended for evaluation exceeded the control threshold.Conclusion:The method is accurate,reliable and easy-to-operate,and the risk of elemental impurities in this sample is low.

In the process of promoting the implementation and transformation of the Q3D guideline of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) in China, the risk assessment of elemental impurities in naturally sourced excipients often faces challenges such as multiple types of elemental impurities and insufficient detection methods. In this paper, an inductively coupled plasma mass spectrometry (ICP-MS) method for screening 12 elemental impurities in titanium dioxide was established using the optimized acid extraction pre-treatment method. The accuracy and repeatability of the method were good. The recoveries of cadmium, lead, mercury, cobalt, nickel, lithium, barium, molybdenum, copper, chromium and iron were 83.6%−101.6%, the recovery of antimony was 54.1%, and the RSD was 1.1%−10.2% (n=6). The evaluation results of elemental impurities showed that the risk of cadmium, mercury, cobalt, nickel, lithium, barium, molybdenum, copper, chromium and antimony was low, while the risk of lead was high, and it is recommended that a lead salt test be added to the pharmacopoeia standard for this product. Based on the statistical data, the differences in the control levels of elemental impurities and whiteness of 29 batches of titanium dioxide samples from 10 domestic and foreign manufacturers were compared and analyzed. The Pearson correlation coefficient method was used to analyze the correlation between residual elemental impurities and whiteness, and a heat map was used to visualize the results. The results showed that whiteness was significantly negatively correlated with the amount of residual barium and the sum of residual elemental impurities. It is suggested that the manufactures should include whiteness as an internally controlled indicator to further improve the quality of titanium dioxide used as a pharmaceutical excipient.

Objective:To explore the status quo and influencing factors of death anxiety among middle-aged and young adult patients with chronic heart failure (CHF) .Methods:Totally 176 middle-aged and young adult CHF patients treated at Fuwai Central China Cardiovascular Hospital between January 2021 and February 2023 were selected by convenience sampling and investigated with a general information questionnaire, the Medical Coping Modes Questionnaire (MCMQ), and the Death Anxiety Scale.Results:A total of 176 questionnaires were distributed, with 170 valid responses, yielding an effective response rate of 96.59%. Among the 170 middle-aged and young adult CHF patients, 136 had low death anxiety, while 34 had high death anxiety. Multiple linear regression analysis showed that educational level, per capita monthly family income, duration of illness, cardiac function classification, physical exercise, and coping style (yielding) were influencing factors of death anxiety in middle-aged and young adult CHF patients ( P<0.05) . Conclusions:Death anxiety in middle-aged and young adult CHF patients is primarily associated with educational level, per capita monthly family income, duration of illness, cardiac function classification, physical exercise, and coping style (yielding). Clinical assessments should focus on these factors to provide timely and targeted psychological interventions.

ObjectiveTo observe the effects of Dendrobium polysaccharides on the secretion of inflammatory cytokines and Toll-like receptor 4 （TLR4）/nuclear factor （NF）-κB pathway in 16HBE cells exposed to cigarette smoke extract （CSE）. MethodThe 16HBE cells were classified into the control， CSE， and CSE+ Dendrobium polysaccharides （100， 200， 400 mg·L^-1） groups. The cell-counting kit-8 （CCK-8） assay was employed to measure the cell viability， and a microscope was used to observe the cell morphology. The enzyme-linked immunosorbent assay was employed to measure the levels of interleukin （IL）-8， IL-1β， IL-4， IL-13， and transforming growth factor （TGF）-β in cell culture supernatants. Real-time PCR was carried out to determine the mRNA levels of Toll-like receptor 4 （TLR4）， nuclear factor-κB （NF-κB）， and IL-4. Western blot was employed to determine the protein levels of interleukin-4 receptor （IL-4R）， TLR4， myeloid differentiation primary response protein 88 （MyD88）， NF-κB， phosphorylated nuclear factor-κB （p-NF-κB）， and nucleoproteins nuclear factor-κB （NEs-NF-κB）. The immunofluorescence assay was employed to measure the nuclear translocation of NF-κB. ResultCompared with the control group， the CSE group showed elevated levels of IL-8， IL-1β， IL-4， IL-13， and TGF-β in the cell culture supernatants （P<0.05， P<0.01）， up-regulated expression levels of TLR4， MyD88， NF-κB， p-NF-κB， NEs-NF-κB， and IL-4 （P<0.01）， and significant nuclear translocation of NF-κB. Compared with the CSE group， Dendrobium polysaccharides increased the cell survival rate， recovered the cell activity， lowered the levels of IL-8， IL-1β， IL-4， IL-13， and TGF-β， down-regulated the expression of TLR4， MyD88， NF-κB， p-NF-κB， NEs-NF-κB， and IL-4 （P<0.05， P<0.01）， and reduced the nuclear translocation of NF-κB. ConclusionDendrobium polysaccharides showed significant protective effects on the 16HBE cells exposed to CSE by inhibiting the TLR4/NF-κB signaling pathway.

Objective:To investigate the application effect of CBL teaching based on mind mapping combined with know-want-learned (KWL) chart in standardized nursing training for neonatal infection.Methods:A total of 58 students who participated in standardized training in Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, were included in the study and were divided into control group and observation group using a simple random number table, with 29 students in each group. The students in the control group were given traditional teaching, and those in the observation group were given CBL teaching based on mind mapping combined with KWL chart. Assessment score was compared between the two groups, and the two groups were compared in terms of self-directed learning ability, critical thinking ability, and evaluation of teaching effectiveness. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:Both groups had significant increases in the scores of theoretical knowledge (91.65±5.17 vs. 84.58±9.14), clinical skills (89.16±6.24 vs. 83.34±7.40), Self-Rating Scale of Self-Directed Learning (257.23±25.79 vs. 241.56±22.74), and Critical Thinking Disposition Inventory-Chinese Version (317.14±38.50 vs. 285.78±34.71) after training, and the observation group had significantly higher scores than the control group ( P<0.05). The observation group had a significantly higher evaluation of teaching effectiveness than the control group ( P<0.05). Conclusion:CBL teaching based on mind mapping combined with KWL chart can improve the assessment scores of students and improve their self-directed learning ability and critical thinking ability, and students have a high evaluation of teaching effectiveness.

Objective:To evaluate the effect of multimodal non-drug treatment during induction of general anesthesia on emergence delirium (ED) in the preschool children.Methods:A total of 210 pediatric patients of either sex, aged 3-6 yr, of American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ, undergoing elective operation for snoring with expected operation time <2 h, were involved in this study. The patients were divided into 2 groups according to the parity of the numbers randomly generated by the computer: multimodal non-drug treatment group (group N, n=102) and control group (group C, n=108). In group N, multiple modes of non-drug intervention (including parents′ company, carrying favorite toys, watching favorite video programs with portable multimedia devices, etc) were used during anesthesia induction, and the children left their parents and entered the operating room after completion of general anesthesia. The children directly entered the operating room with the medical staff for anesthesia induction (without parents′ company and other intervention measures) in group C. The patients were endotracheally intubated and received combined intravenous-inhalational anesthesia and general anesthesia in both groups. The anxiety was evaluated by modified Yale preoperative anxiety scale (m-YPAS) score at 24 h before operation (T 0) and immediately before induction of general anesthesia (T 1). The Pediatric Anesthesia Emergence Delirium scale score (PAED score, ED was defined as PAED score > 12), FLACC scale score and Ramsay Sedation Scale score were recorded when orientation recovered after admission to postanesthesia care unit (T 2) and at 6, 24 and 72 h after operation. The patients were divided into ED group and non-ED group (NED group) according to the occurrence of ED, and the risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify ED-related risk factors and construct the prediction model. The accuracy of the prediction model was evaluated by the receiver operating characteristic curve. Results:Compared with group C, the m-YPAS at T 1 and PAED score and incidence of ED at T 2 were significantly decreased ( P<0.05), and no significant change was found in FLACC score and Ramsay sedation score at all time points in group N ( P>0.05). Age, m-YPAS score at T 1, multimodal non-drug treatment during anesthesia induction, FLACC score at T 2 and Ramsay sedation score at T 2 were the risk factors for ED ( P<0.05). The area under the receiver operating characteristic curve was 0.944, the 95% confidence interval was 0.914-0.974, with a Yonden index of 0.779, sensitivity of 94.9%, specificity of 83%, and the cutoff value of 0.14. Conclusions:Multimodal non-drug treatment during induction of general anesthesia can effectively reduce the development of ED in the preschool children.