Objective:To explore the association between triglyceride glucose index (TyG)- waist to height ratio (WHtR)(TyG-WHtR) and cognitive impairment in middle-aged and elderly population.Methods:A cohort database was constructed using the data from the China Health and Retirement Longitudinal Study, with 8 946 participants in 2011 and 2015 as the baseline population. Cox proportional hazards regression models were used to estimate the association between TyG-WHtR levels at baseline and the risk of cognitive impairment in middle-aged and elderly population. The analysis was stratified by age and gender, respectively.Results:A total of 8 946 participants were included, with an average follow-up of 7.08 person-years and incidence density of cognitive impairment for 21.15 per 1 000 person-years. Compared with the Q1 level of TyG-WHtR, its Q3 and Q4 level increased the risk of cognitive impairment by 32% ( HR=1.32, 95% CI: 1.09-1.60) and 47% ( HR=1.47, 95% CI: 1.14-1.91), respectively. Trend test showed that the risk of cognitive impairment increased with the increase of TyG-WHtR level, and there was a dose-response relationship ( P=0.001). Stratified analysis showed that in the population aged 45-59 years, compared with the Q1 level of TyG-WHtR, its Q3 level increased the risk of cognitive impairment by 34% ( HR=1.34, 95% CI: 1.02-1.78). In the population aged 60 years and above, compared with the Q1 level, its Q3 and Q4 level increased the risk of cognitive impairment by 31% ( HR=1.31, 95% CI: 1.01-1.72) and 63% ( HR=1.63, 95% CI: 1.15-2.31), respectively. In the male group, there was no significant association between TyG-WHtR level and the risk of cognitive impairment ( P>0.05). In the female group, compared with the Q1 level of TyG-WHtR, its Q4 level increased the risk of cognitive impairment by 76% ( HR=1.76, 95% CI: 1.26-2.46). Conclusions:Middle-aged and elderly population with a higher TyG-WHtR level may increase the risk of cognitive impairment, and there were age and sex differences. Early cardiovascular health management and scientific and reasonable weight management are of great significance to preventing cognitive impairment.

Objective:To investigate the effects of attention and interpretation therapy on fatigue and sleep quality in patients with gastrointestinal tumor during chemotherapy.Methods:From December 2018 to December 2019, eighty-four patients with gastrointestinal tumor hospitalized in two hospitals (third-grade class-A) in Ningxia were selected as the research objects. According to the random number table, they were divided into the control group and the observation group with 42 cases in each group. Patients in the two groups received routine care. On this basis, the observation group received 10 weeks of attention and interpretation therapy. Cancer patients fatigue scale and Pittsburgh sleep quality index(PSQI) scale were used to evaluate before intervention, 10 weeks after intervention and 3 months after intervention. SPSS 17.0 software was used for statistical analysis. Independent sample t-test and repeated measure analysis of variance were used for comparison between groups. Results:(1) The time effect, inter group effect and interaction effect of fatigue total scores and each dimension score of the two groups were significant (all P<0.01). Further simple effect analysis showed that there were significant differences in the total score and each dimension score of fatigue between the control group and the observation group at 10 weeks after intervention and 3 months after intervention (all P<0.01). (2) The time effect, inter group effect and interaction effect of PSQI total score, sleep quality, sleep time, sleep disorder score were significant (all P<0.01), but the time effect, inter group effect and interaction effect of sleep efficiency, daytime dysfunction and hypnotic drug use score were not significant (all P>0.05). Further simple effect analysis showed that there were significant differences in PSQI total score, sleep quality, sleep time, sleep time and sleep disorder scores between the control group and the observation group 10 weeks after the intervention(PSQI total score (6.83±2.46) vs (10.79±1.01); sleep quality (1.00±0.22) vs (1.24±0.82); sleep time (0.91±0.26) vs (1.40±0.86); sleep time (1.00±0.20) vs (2.02±0.72); sleep disorder (0.79±0.22) vs (1.60±0.59) and 3 months after the intervention(all P<0.01). Conclusion:Attention and interpretation therapy can effectively alleviate the fatigue of gastrointestinal tumor patients during chemotherapy, and improve sleep quality.

Objective:To explore the feasibility in evaluating segmental extracellular volume (ECV) using dual-layer spectral detector CT in patients with heart failure with various percentages of delayed hyper-enhanced volume, using MRI as a reference.Methods:Twenty-seven patients with heart failure in Peking Union Medical College Hospital were prospectively enrolled in this study from July 2019 to January 2021. All the patients underwent both CT late iodine enhancement and MR late gadolinium enhancement imaging within a week. According to percentages of hyper-enhanced volume on cardiac MR image, myocardial segments were classified into 3 groups: 0-4% (group A), 5%-49% (group B) and 50%-100% (group C). ECV images were independently observed by 2 experienced radiologists. The correlation and agreement between CT-ECV and MRI-ECV for the whole myocardial assessment and for the segmental assessment were evaluated using Spearman correlation and Bland-Altman analysis. Inter-observer agreement was assessed using the ICC.Results:Of the 27 patients, 432 segments were analyzed, with 199 segments in group A, 151 segments in group B and 82 segments in group C. In the whole myocardial analysis, the CT-ECV and MRI-ECV were 32.25% (28.04%, 34.28%) and 32.27% (28.35%, 34.77%), respectively. A good correlation was found between CT-ECV and MRI-ECV ( r=0.969, P<0.001). Bland-Altman analysis between CT-ECV and MRI-ECV showed a small bias (0.4%), with 95% limits of agreement of -6.9% to 7.8%. as for the segmental myocardial assessment, the CT-ECV was 28.23% (26.18%, 29.92%) for group A, 33.29% (30.16%, 35.96%) for group B and 40.22% (34.06%, 46.70%) for group C. There was statistically significant difference in ECV among three groups (all P<0.001). Good correlations between CT-ECV and MRI-ECV were found in group A ( r=0.614, P<0.001), group B ( r=0.852, P<0.001) and group C ( r=0.953, P<0.001). Bland-Altman analysis between CT-ECV and MRI-ECV showed a small bias 2.0% (95% limits of agreement:-17.6%-21.6%) in group A, a small bias -0.4% (95% limits of agreement: -13.8%-12.9%) in group B and a small bias -1.8% (95% limits of agreement: -17.4%-13.9%) in group C. The ICC values between 2 observers were 0.877 and 0.945 on CT-ECV and MRI-ECV, respectively. Conclusions:The larger percentage of hyper-enhanced volume on cardiac MR image, the stronger correlation are between the CT-ECV and MRI-ECV. CT-ECV may be taken as an alternative tool for quantitative evaluation of myocardial tissue in patients with heart failure.

Objective To compare the dosimetric difference of target and organs-at-risk between intensity-modulated radiotherapy (dIMRT) and volumetric modulated arc therapy (VMAT) for bilateral breast cancer, so as to discuss the clinical feasibility of radiotherapy for bilateral breast cancer. Methods The clinical data of 18 patients receiving radical or modified radical mastectomy for confirmed bilateral breast cancer were enrolled in this study. dIMRT plans and VMAT plans were designed for each patient, and discuss the dosimetric data of two radiotherapy plans. Results Both the two plans satisfied the prescription. In terms of the homogeneity index, VMAT plans (0.09 ± 0.02) were superior to dIMRT plans (0.11 ± 0.01, P < 0.05). In terms of the conformity index,VMAT plans (0.82 ± 0.52) were superior to dIMRT plans (0.71 ± 0.51, P < 0.05). Furthermore, VMAT plans (0.98 ± 0.06) were superior to dIMRT plans (1.24 ± 0.08, P < 0.05) in the dose gradient index. The V₁₀、V₂₀、V₃₀ and D_mean of lungs in VMAT plans (39.07 ± 4.92，22.19 ± 4.36，12.81 ± 4.71，1309.03 ± 135.55) were higher than those in dIMRT plans (30.34 ± 4.26，17.56 ± 4.31，6.77 ± 3.93，1201.39 ± 166.77, P < 0.05).Meanwhile, the V₅ of lungs in VMAT plans (63.36 ± 9.02) was higher than that in dIMRT plans (58.01 ± 7.17, P > 0.05). However, the V₅、V₃₀ and D_mean of heart in VMAT plans (51.98 ± 3.60，3.78 ± 1.76，885.89 ± 59.84) were lower than those in dIMRT plans (77.16 ± 12.11，5.22 ± 2.85，1036.96 ± 151.46, P < 0.05). The D_max of spinal cord in VMAT plans (2150.42 ± 136.19) was significantly lower than that in dIMRT plans (3008.23 ± 304.15, P < 0.05). Monitor units in VMAT plans（792.61 ± 62.53）was significantly lower than that in dIMRT plans (3225.33 ± 498.66, P < 0.05). Conclusion Although VMAT has many advantages: achieves better homogeneity index and conformity index of target areas, reduces the irradiation dose of organs-at-risk, especially, the irradiation dose of heart and spinal cord is significantly reduced, however, it increases the irradiation dose of lungs. To reduce the recurrence of grade ≥ 2 radiation pneumonia, dIMRT should be better considered in the application of radiotherapy for bilateral breast cancer.

Objective:To investigate the distribution characteristics of atherosclerosis in patients with obstructive sleep apnea syndromes (OSAS) by ultrasonography and explore the differences of intracranial and extracranial atherosclerosis lesions.Methods:From July 2016 to July 2019, 139 patients with OSAS confirmed by the department of neurology and/or respiratory of Xuanwu Hospital, Capital Medical University were enrolled retrospectively. According to the results of polysomnography (PSG), patients were divided into 3 groups: mild degree (53 cases), moderate degree (35 cases) and severe degree (51 cases). Demographic parameters, distribution and the severity of atherosclerosis both in intracranial and extracranial arteries, and the incidence of ischemic stroke were compared among the three groups.Results:①Among 139 OSAS patients, there were more males (64.7%) than females (35.3%). Of all the risk factors for cerebrovascular diseases, the prevalence of hypertensin was the highest (50.4%), followed by hyperlipidemia (48.9%). The prevalences of hypertension and ischemic stroke, the body mass index (BMI) in severe OSAS group were higher than those in mild group (all P<0.017). ②The total detection rate of extracranial atherosclerosis (83.5%) was significantly higher than that of intracranial atherosclerosis (23.0%)( P<0.01). ③The extracranial atherosclerotic lesion with highest detection rate of was simple plaque formation (51.1%, 71/139 cases), and there was no significant difference in extracranial lesions among the three groups ( P=0.106). However, with the aggravation of OSAS degree, the stenosis degree of extracranial artery increased ( P=0.006), and there was a weak correlation between the severity of OSAS and the degree of extracranial artery stenosis ( r s=0.263, P=0.002). ④The incidence of middle cerebral artery stenosis accounted for 15.8%(22/139 cases) of intracranial arteries involved and there were no significant differences in the rate, degree and distribution of intracranial artery lesions among the three groups (all P>0.05). Conclusions:The detection rate of extracranial arterial lesions in OSAS patients is higher. With the aggravation of OSAS, the degree of atherosclerosis stenosis in extracranial arteries and the incidence of ischemic stroke trend to increase.

Objective To study the difference of clinical outcome between late preterm twins (LPT) and late preterm singletons (LPS),and the influence of assisted reproduction technology (ART) or natural conception on the clinical outcomes of LPT.Method The data of late preterm infants born in the Beijing Obstetrics and Gynecology Hospital between January 2016 and January 2018 were retrospectively collected.Infants were assigned to LPT group or LPS group according to twins or singleton status.The differences of the demographic data,morbidity,oxygen therapy rate,respiratory support rate,mortality,hospitalization rate and hospitalization time between LPT and LPS were compared.In order to analyze the effects of different ways of conception on LPT,LPT was further divided into assisted reproduction technology (ART) subgroup and natural pregnancy subgroup.Result A total of 1 824 late preterm infants were included in the study,including 582 cases of LPT and 1 242 cases of LPS.The birth weight and body length of LPT were lower than those ofLPS [(2572±395)gvs.(2614±413)g,P＜0.05;(46.5±1.1)cm vs.(47.5 ± 1.0)cm,P ＜0.01],while the cesarean delivery rate of LPT was higher than that of LPS [90.7％ (528/582) vs.39.9％ (496/1 242),P ＜ 0.01].The incidence of respiratory distress syndrome (RDS) in LPT was higher than that of LPS [5.2％ (30/582) vs.3.6％ (45/1 242),P ＜ 0.05],and the length of hospitalization of LPT was also longer than that of LPS[(8.9 ±3.1)d vs.(7.2 ±2.9)d,P ＜0.01],the differences were statistically significant.There were no significant differences between groups in neonatal pneumonia,apnea,hypoglycemia,sepsis,neonatal necrotizing enterocolitis (NEC),grade Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,bronchopulmonary dysplasia (BPD),oxygen therapy rate,respiratory support rate and mortality rate.There was also no significant difference between ART subgroup and natural pregnancy subgroup in gestational age,gender,cesarean section rate,birth weight,and birth length (P ＞ 0.05).There was no significant difference in RDS,pneumonia,apnea,hypoglycemia,sepsis,NEC,Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,BPD,oxygen uptake rate,respiratory support rate,mortality rate and hospitalization time between the two subgroups (P ＞ 0.05).Conclusion The birth weight and birth length of LPT are lower than those of LPS,and the incidence of RDS is higher.The hospitalization time of LPT is also longer than that of LPS.It is necessary to strengthen the high-risk management of twin pregnant women and post-natal management of LPT.

Objective To study the urinary arsenic safety guideline value of a population for evaluating the arsenic exposure level in a certain population and providing evidence for the implementation of prevention and control measures in endemic arsenicosis area.Methods According to the data from the national high-arsenic drinking water sources screening in endemic arsenicosis area of drinking water type and quality supervision and inspection for water-improving project to decrease arsenic from 2005 to 2014,census data on arsenic poisoning in endemic arsenicosis area,data on surveillance of endemic arsenicosis,10 722 people with detailed personal information,complete water arsenic exposure data and accurate urinary arsenic detection data were selected to be the research objects.The relationship between urinary arsenic and water arsenic was analyzed based on the surveillance data of 4 501 people from 2013 to 2014.The safety guidance value of urinary arsenic was determined based on the geometric mean value of urinary arsenic in people exposed to water arsenic in the range of (0.050 ± 0.005) mg/L,and verified using the data of 6 221 people from 2005 to 2012.Every time,a random sample of 2 000 people was taken as the verification sample,the sensitivity and specificity of the index for determining whether water arsenic exposure exceeded the standard were determined by area under the ROC curve (AUC),and a total of 10 sample tests was performed.Results When the water arsenic concentration was less than 0.01 mg/L,the correlation coefficient of water arsenic concentration with urinary arsenic concentration was 0.097 (P ＜ 0.01);when the water arsenic concentration was more than 0.01 mg/L and less than 0.05 mg/L,the correlation coefficient of arsenic concentration with water arsenic concentration was 0.456 (P ＜ 0.01);when the water arsenic concentration was more than 0.05 mg/L,the correlation coefficient of water arsenic concentration with urinary arsenic concentration was 0.630 (P ＜ 0.01).With increase of water arsenic concentration,the concentration of urinary arsenic increased significantly,and the difference was statistically significant (x2 =2 337.956,P ＜ 0.01).When water arsenic concentration was in the range of (0.050 ± 0.005) mg/L,the urinary arsenic geometric mean was 0.032 mg/L.AUC analysis of 10 random samples of 2 000 people showed that the geometric mean of urinary arsenic was 0.032 mg/L in the population,which can accurately distinguish whether the water arsenic level exceeded 0.05 mg/L,and the AUC value was higher than 0.94.And the sensitivity and specificity were achieved 0.898 and 0.844.Conclusions The geometric mean of urinary arsenic is 0.032 mg/L,which can be used as a safety guideline value for urinary arsenic in the population.When the geometric mean of urinary arsenic exceeds this value,the population may be exposed to high arsenic.

Objective To explore the application effect of quality control circle (QCC) management tool on improving the correct rate of intravenous chemotherapy path selection in lung cancer patients in Oncology Department.Methods QCC group was set up and the activity theme was established as "improving the correct rate of intravenous chemotherapy path selection in lung cancer patients". The whole process consisted of status investigation, goal setting, cause analysis and countermeasures implemented according to quality control principle. The choice of intravenous chemotherapy path before and after QCC activity and patients' compliance to the choice of intravenous chemotherapy path were observed. In addition, 8 aspects abilities' improvement of every member in the QCC group were investigated before and after the activity.Results After carrying out QCC, the correct rate of the path choice for intravenous chemotherapy of lung cancer patients increased from 38.14％％ to 58.74％ (P<0.05), and the progress rate was 54.01％. The proportion of patients' full compliance increased to 93.97％ from 79.52％ (P<0.05). The QCC members' 8 aspects abilities improved by 14.71％ to 80.77％.Conclusions Applying QCC in managing and monitoring the intravenous chemotherapy path selection can effectively improve the correct rate of path choice, so as to ensure patients' safety in intravenous chemotherapy.

Objective:To explore the clinical effect of intravenous immunoglobulin combined with conventional therapy in the treatment of severe pneumonia in infants and children.Methods:Selected the January 2015 to April 2016 in our hospital for treatment of 88 cases of children with severe pneumonia were retrospectively analyzed,which 47 cases by routine treatment plus intravenous immunoglobulin protein (treatment group),41 cases of children only take routine therapy (control group),with a course of 2 weeks.Results:The symptoms of fever,dyspnea,cough,wheezing,pulmonary rales were improved faster in the treatment group than the control group (P＜0.05);after 2 weeks of treatment,IgG levels were significantly higher in the treatment group than the control group(P＜0.05);after 2 weeks of treatment,the serum IL-6 and TNF-α levels were significantly lower in the treatment group than the control group(P＜ 0.05);after 1 week of treatment,57.45％ of patients was cured in the treatment groups while only 34.15％ patients in the control group (P＜0.05).Conclusion:Intravenous immunoglobulin combined with conventional therapy in the treatment of infants with severe pneumonia can significantly improve the theraputic effect and enhance blood immunoglobulin levels.

Objective To structure the evaluation index system for nursing speciality development (EISNSD) in tertiary hospitals.Methods The evaluation index system for nursing specialty developmentwas established using a Delphi method. The weight coefficient at all levels was calculated by the analytic hierarchy process. The standard value of the index was set by multiple ways including target plan, industry regulation, historical data and so on. A total of 48 departments from three tertiary hospitals in Shanghai were investigated. The reliability and validity of the evaluation indexes were analyzed with Cronbach′s alpha coefficients and Spearman correlation.Results The EISNSD was structured with five primary indexes, 14 secondary indexes and 75 third indexes. The weight coefficients of primary indicators included 0.2859 for talent echelon building, 0.3772 for nursing practice, 0.1095 for teaching level, 0.1444 for scientific research and 0.0830 for the construction of professional training base. The correlation between indexes at all levels and their indexes of higher level was from 0.583 to 0.920 (P<0.01). The reliability of all indexes at all levels was from 0.581 to 0.945 with 0.931 for the reliability of total index.Conclusions The EISNSD in tertiary hospitals is of a strong scientificity and practicability. It can provide the quantiative basis for objective evaluation and continuity management of nursing specialty development of all departments in tertiary hospitals.