Objective:To summarize the best evidence for non-pharmacological management of restless leg syndrome (RLS) in patients with chronic kidney disease.Methods:Based on the "6S" evidence model, a computer search was conducted on relevant domestic and international guideline websites and databases, including Guidelines International Network, National Guideline Clearinghouse, Registered Nurses' Association of Ontario, Medlive, Chinese Medical Association Nephrology Branch, National Kidney Foundation website, BMJ Best Practice, UpToDate, PubMed, Cochrane Library, China Biology Medicine disc, and China National Knowledge Infrastructure. The search period was from establishing the databases to September 30, 2023. Two researchers conducted a literature quality evaluation and summarized evidence.Results:A total of 11 articles were included, including two guidelines, two clinical decision-making articles and seven systematic reviews. A total of 30 pieces of evidence were summarized from nine aspects, such as evaluation and management, avoidance of triggering factors, behavioral strategy changes, physical therapy, change in dialysis methods, exercise therapy, surgery, traditional Chinese medicine external treatment, and health education.Conclusions:This study summarizes the best evidence for non-pharmacological management of restless leg syndrome in patients with chronic kidney disease. Medical staff must select and apply the best evidence in a targeted manner based on clinical situations.

Objective:To conduct a scoping review to analyse the types, performance, advantages and disadvantages of cognitive function assessment tools for ICU patients, to provide a reference for the evaluation of cognitive function in ICU patients in future.Methods:A scoping review study was conducted, literature on cognitive function assessment tools for ICU patients in 9 domestic and foreign databases including China National Knowledge Infrastructure, Wanfang Database, VIP Database, China Biology Medicine disc, PubMed, Web of Science, Cochrane Library, Embase and CINAHL were systematically searched. The search period was from the establishment of the database to May 20, 2024. Literature was independently screened by 2 researchers and relevant information was extracted and summarized.Results:Totally 17 studies were included, with 9 tools for assessing cognitive function in ICU patients, including 6 questionnaires, 1 test battery, 1 assessment software, and 1 telephone interview questionnaire. All of above were generalizable tools, except for the Chinese and English versions of the John-Hopkins Adapted Cognitive Exam as ICU-specific tools. The Mini-Mental State Examination was the most widely used assessment scale.Conclusions:Appropriate assessment tools should be selected according to the specific clinical setting, but there is still a lack of specialized and standardized assessment tools for cognitive dysfunction in ICU patients. In the future, standardized tools which fit our cultural context for evaluating cognitive function in ICU patients should be developed.

Objective:To explore the expressions of serum N-terminal osteocalcin (N-MID) and cytokeratin (CK) 5/6 in primary lung cancer patients with bone metastasis and their clinical significances.Methods:The clinical data of 96 patients with primary lung cancer admitted to Chengdu Second People's Hospital between February 2019 to February 2022 were retrospectively analyzed. All patients were divided into the bone metastasis group (38 cases) and the non-bone metastasis group (58 cases) according to whether bone metastasis occurred, and 45 healthy people who underwent physical examination during the same period were treated as the healthy control group. The expression levels of serum N-MID and CK5/6 in the bone metastasis group, the non-bone metastasis group and the healthy control group were compared. Logistic regression was used to analyze the factors affecting bone metastasis in patients with primary lung cancer; receiver operating characteristic (ROC) curve analysis was used to analyze the value of the expression levels of serum N-MID and CK5/6 in predicting bone metastasis in patients with primary lung cancer.Results:The composition ratio of patients with pathological stage Ⅲ-Ⅳ, serum bone-derived alkaline phosphatase and N-MID expression levels in the bone metastasis group were higher than those in the non-bone metastasis group (all P < 0.05). The expression level of serum N-MID in the bone metastasis group and non-bone metastasis group was higher than that in the healthy control group [(26.0±5.3) ng/ml, (15.3±3.1) ng/ml vs. (9.9±1.7) ng/ml, F = 224.27, P < 0.001], and there were statistically significant differences in the serum N-MID expression level of the pairwise comparison among the three groups (all P < 0.05). The expression level of serum CK5/6 in the bone metastasis group and the non-bone metastasis group was lower than that in the healthy control group [(3.6±0.7) ng/ml, (7.3±1.4) ng/ml vs. (10.6±2.4) ng/ml, F = 178.11, P < 0.001], and there were statistically significant differences in the serum CK5/6 expression level of the pairwise comparison among the three groups (all P < 0.05). Multivariate analysis showed that CK5/6, N-MID and bone-derived alkaline phosphatase were independent affecting factors for bone metastasis in patients with primary lung cancer ( OR = 4.088, 3.615, 2.892, all P < 0.05). ROC curve analysis showed that the optimal cut-off values of serum N-MID and CK5/6 expression levels for predicting bone metastasis in patients with primary lung cancer were 18.59 ng/ml and 4.71 ng/ml; the corresponding the area under the curve (AUC) was 0.881 and 0.862, respectively; and the specificity and AUC of the combination of serum N-MID and CK5/6 in predicting the bone metastasis in patients with primary lung cancer was 98.28% and 0.937 (95% CI 0.869-0.977), respectively; the AUC predicted by the combination of both was higher than that by serum N-MID or CK5/6 single (all P < 0.001). Conclusions:The expression levels of serum N-MID and CK5/6 in primary lung cancer patients with bone metastasis are abnormally changed. Clinical detection of serum N-MID and CK5/6 expression levels may be used as sensitive indicators for predicting the bone metastasis in patients with primary lung cancer.

Objective:To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia (COVID-19), bacterial pneumonia and other viral pneumonia.Methods:Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed, including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020, 16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020, and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020. Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease.Results:Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia, and the incidence was significantly higher than that of bacterial pneumonia (91.6%, 75.0% vs. 26.0%, P < 0.05). Compared with other viral pneumonia and COVID-19, bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion (62.0% vs. 18.8%, 5.6%, P < 0.05), accompanied by pleural effusion and lymph node enlargement. The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%, that of patients with other viral pneumonia was 56.2%, and that of patients with bacterial pneumonia was only 2.0% ( P < 0.05). The incidence rate of lung tissue consolidation (25.0%, 12.5%), air bronchial sign (13.9%, 6.2%) and pleural effusion (16.7%, 37.5%) in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia (62.0%, 32.0%, 60.0%, all P < 0.05), paving stone sign (22.2%, 37.5%), fine mesh sign (38.9%, 31.2%), halo sign(11.1%, 25.0%), ground-glass opacity with interlobular septal thickening (30.6%, 37.5%), bilateral patchy pattern/rope shadow (80.6%, 50.0%) etc. were significantly higher than those of bacterial pneumonia (2.0%, 4.0%, 2.0%, 0%, 22.0%, all P < 0.05). The incidence of local patchy shadow in patients with COVID-19 was only 8.3%, significantly lower than that in patients with other viral pneumonia and bacterial pneumonia (8.3% vs. 68.8%, 50.0%, P < 0.05). There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19, other viral pneumonia and bacterial pneumonia (27.8%, 12.5%, 30.0%, P > 0.05). Conclusions:The probability of ground-glass opacity, paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia, and it was more common in the lower lungs and lateral dorsal segment. In other patients with viral pneumonia, ground-glass opacity was distributed in both upper and lower lungs. Bacterial pneumonia is usually characterized by single lung consolidation, distributed in lobules or large lobes and accompanied by pleural effusion.

Objective:To study the safety of different peripherally inserted central catheter (PICC) dressing replacement frequencies in preterm infants.Method:From June 2017 to February 2020, preterm infants were enrolled in this prospective randomized controlled study. Preterm infants with PICC were randomly assigned into 7 d, 11 d and 14 d dressing replacement groups using online randomization software. Polyurethane transparent dressing and the same dressing replacement method were used in all three groups. The incidences of catheter-related bloodstream infection (CRBSI) and positive skin bacterial culture at dressing site were compared among the three groups.Result:A total of 296 cases were enrolled, including 96 cases in the 7 d group, 108 cases in the 11 d group and 92 cases in the 14 d group. The incidences of CRBSI in three groups were 2.5/1 000 catheter day in 7 d group, 1.1/1 000 catheter day in 11 d group and 0.8/1 000 catheter day in 14 d group. The incidences of catheter pathogen colonization were 1.0% in 7 d group, 0.9% in 11 d group and 0% in 14 d group. The positive rates of skin bacterial culture at dressing site were 1.0% in 7 d group, 2.8% in 11d group and 2.2% in 14 d group. The incidences of PICC exit site infection in three groups were 1.0% in 7 d group, 0.9% in 11d group and 1.1% in 14 d group and no significant differences existed among the groups ( P>0.05). Gram-positive cocci were the main bacteria [91.7% (11/12)] of CRBSI and skin bacterial culture at dressing site and gram negative bacilli accounted for 8.3% (1/12). No fungal infection were found. Conclusion:It is safe to replace the PICC dressing in premature infants as needed within 14 days if the dressing is intact without curling, bleeding and exudation.

OBJECTIVE：To study the mecha nism of Bambuterol hydrochloride in the improvement of chronic obstructive pulmonary disease （COPD）model rats ，and to find the potential biomarker. METHODS ：Totally 30 rats were randomly divided into normal group ，model group and bambuterol hydrochloride group （3.3 mg/kg），with 10 rats in each group ；COPD model was established by lipopolysaccharide （LPS）infusion combined with smoking in model group and bambuterol hydrochloride group. After modeling ，bambuterol hydrochloride group was given relevant medicine intragastrically ，normal group and model group were given constant volume of normal saline intragastrically ，once a day ，for consecutive 45 d. After last medication ，the serum sample and alveolar lavage fluid of rats were collected. The levels of interleukin- 6（IL-6）and tumor necrosis factor-α（TNF-α）in alveolar lavage fluid were detected by ELISA. The serum metabolites were detected by LC-MS and analyzed by metabolomics. Orthogonal partial least squares discriminant analysis （OPLS-DA）was used to screen out the differential metabolites. The potential biomarkers were identified based on the related literature ，and the metabolic pathway enrichment analysis was carried out by MetPA analysis platform. RESULTS ：Compared with normal group ，the levels of IL- 6 and TNF-α in alveolar lavage fluid of rats were increased significantly in model group （P＜0.05）. Compared with model group ，the levels of IL- 6 and TNF-α in alveolar lavage fluid of rats were decreased significantly in bambuterol hydrochloride group （P＜0.05）. Results of metabolomics and OPLS-DA showed that 21 differential metabolites and 12 potential biomarkers were found （including maleylpyruvate ， hydroxypyruvate， tartronate semialdehyde，etc.）. Bambuterol hydrochloride can significantly reduce the levels of maleylpyruvate ，methylselenocysteine and 5-deoxy-D-glucuronic acid （P＜0.05）， while increase the levels of hydroxypyruvate ， tartronate semialdehyde and. These biomarkers were mainly @163.com concentrated in pentose phosphoric acid pathway ，glyoxyli acid and tricarboxylic acid metabolism pathway ，followed by 开发。E-mail：pn333@163.com inositol phosphoric acid metabolism pathway ，arginine and tyrosine metabolism pathway ，glycine，serine and threonine metabolism pathway. CONCLUSIONS ：The mechanism of bambuterol hydrochloride improving COPD may be associated with the decrease of the levels of TNF-α and IL-6，as well as the pathway of amino acid metabolism ，energy metabolism and lipid metabolism.

For the safety problems of internal medicine intravenous infusion,we carry out meticulous management,establish quality control system of intravenous infusion safety management,and formulate quality control plan.We collect and analyse the potential unsafety factors in the various departments of internal medicine.We have revised the intravenous infusion system and procedures,formulated standards for safety inspection of intravenous fluids,and standardized the admission system for nurses.We carry out training on intravenous infusion related knowledge for nursing staff,carry out meticulous management of venous transfusion links,and actively carry out learning and communication.All these measures have greatly enhanced the safety awareness of the nursing staff.The safety index of intravenous infusion for liver diseases was preliminarily summarized.The use rate of the safe indwelling needle was increased from 30.60％ to 92.30％,the rate of appropriate rate of drop speed increased from 68.45％ to 93.20％,the three sign standard rate rose from 75.20％ to 95.10％,and the patient's satisfaction with infusion increased from 85.60％ to 96.82％.Meticulous management can improve the safety of the internal medicine intravenous infusion as a whole.

Objective The aim of this study was to investigate the mechanism underlying pruritus by comparing the epidermal growth factor receptor inhibitor(EGFRI)-erlotinib mouse model with the substance P(SP)-induced pruritus mouse model. Methods Two randomized groups of mice were treated with erlotinib or SP to induce pruritus. Behavioral and skin manifestations were observed. Pathological images and neurokinin 1 receptor(NK-1R)expression of the skin were determined. Concentration of interleukin(IL)-31, IL-33, histamine, leukotriene B4, and SP was analyzed by enzyme-linked immunosorbent assay. Nitric oxide was analyzed by colorimetry. Results Transient pruritus induced by erlotinib appeared 2 to 5 days after treatment. In contrast, continuous pruritus was observed during the first hour, but was then gradually relieved. These two shared similar scratching behavior. Concentration of neurotransmitters showed similar trends in changes among the erlotinib group and SP group. Immunohistochemical expression was also consistent between the erlotinib group and SP group. Conclusions Erlotinib-associated pruritus is related to release of signaling factors through the SP/NK-1R signaling pathway.

Objective To understand the molecular epidemiology of penicillin resistance Streptococcus pneumonia (PNSP) isolated from children in Guangzhou area to provide the experimental basis for clinical prevention and control of Streptococcus pneumonia infectious diseases.Methods Specific primers were designed according to Genebank,penicillin binding protein(PBP) genes PBP1A,PBP1B,PBP2A,PBP2B,PBP2X,PBP3 were amplified by PCR.The sequencing analysis was performed.The PCR products were digested by Hinf I,and the restriction fragment length polymorphism (RFLP) was analyzed.Results DNA of PNSP was successfully extracted,the PCR results showed that in 50 strains of PNSP,the positive rates of bacterial strains containing PBP1A,PBP1B,PBP2A,PBP2B,PBP2X and PBP3 were 48.9%,64.4%,71.1%,31.1%,40.0% and 31.1% respectively.The sequencing showed that their homologies with known sequences in GenBank were 99%,98%,100%,97%,95% and 100% respectively.Using RFLP in Hinf I showed that PBP1A,PBP1B,PBP2A and PBP3 only had one kind of genotype,PBP2B and PBP2X had two kinds of genotypes,the positive rates were 71.4%,28.6%,66.7% and 33.3% respectively.Conclusion The gene distribution of PNSP strains among children in Guangzhou is dominated by PBP2A,PBP1B and PBP1A,there are two subtypes in PBP2B,PBP2X when digested by Hinf I,in which the predominant subtype >65%.

Objective To investigate the relationship between neonatal asphyxia and meconium and fetal heart rate monitoring. Methods A total of 675 cases of newborns born birth selected from January 2012 to July 2013 in our hos-pital were retrospective analyzed, neonatal asphyxia were 131 cases, according to the degree of asphyxia they were di-vided into two groups, the mild asphyxia group had 75 cases, the severe asphyxia group had 56 cases. According to whether had meconium and the degree they were divided into four groups, the amniotic fluid clear group had 26 cases, degree Ⅲ neonatal pollution group had 31 cases, degree Ⅱ neonatal pollution group had 48 cases, degree Ⅰ neonatal pollution group had 26 cases. Results The neonatal asphyxia rate of neonatal pollution group was significantly higher than amniotic fluid clear group, the difference was significant (P<0.05). The fetal heart monitor newborns abnormal in-cidence of the amniotic fluid clear group were significantly higher than varying degrees of neonatal pollution groups, the difference was significant (P<0.05). The incidence of abnormal fetal heart monitor newborns of degree Ⅲneonatal pol-lution group, degree Ⅱ neonatal pollution group and degree Ⅰ neonatal pollution group were lower in turn, there was significant difference among three groups(P<0.05). Conclusion Neonatal asphyxia, meconium and fetal heart rate moni-toring correlation larger obstetric clinicians want to pay close attention to the whole process of childbirth, the incidence of neonatal asphyxia is significantly reduced.