OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

BackgroundThe comorbidity rate of bipolar disorder and borderline personality disorder （BPD） is high， and the cognitive impairment of comorbidity patients is more serious. ObjectiveTo explore the difference of cognitive function between bipolar disorder patients with BPD or not， so as to provide references for clinical diagnosis and treatment. MethodsUsing simple random sampling， 60 patients with bipolar disorder comorbidity BPD treated in the First Hospital of Hebei Medical University from April 2021 to April 2022 were selected as the research group， including 33 patients with bipolar depression and 27 patients with bipolar mania. At the same time， 60 patients with bipolar disorder were randomly selected as the control group， including 35 patients with bipolar depression and 25 patients with bipolar mania. The cognitive function of patients was evaluated by the Chinese version of Repeatable Battery for the Assessment of Neuropsychological Status （RBANS） and the Stroop Color Word Test. ResultsThe immediate memory， visual span， speech function and total score of RBANS in the comorbid group were lower than those in the non-comorbid group， and the differences were statistically significant （t=-2.356， -2.138， -3.306， -2.729， P<0.05 or 0.01）. The single word time， single color time， double word time and double color time in Stroop Color Word Test in comorbid group were longer than those in non-comorbid group， and the differences were statistically significant （t=4.808， 3.341， 5.249， 5.167， P<0.01）. The immediate memory， visual span， speech function and total score in RBANS of bipolar depression patients with comorbid BPD were lower than those of bipolar depression patients without comorbid BPD （t=-2.446， -2.407， -2.231， -2.078， P<0.05）， and the time of single word， single color， double word and double color in Stroop Color Word Test were longer than those of non-comorbid BPD patients （t=-3.652， 3.035， 4.406， 5.016， P<0.01）. The speech function and total score of RBANS in bipolar manic patients in comorbid group were higher than those in non-comorbid group （t=-2.777， -2.347， P<0.05 or 0.01）， and the time of single word， single color， double word and double color in Stroop Color Word Test were longer than those in non-comorbid group （t=3.600， 2.658， 2.943， 4.337， P<0.05 or 0.01）. ConclusionThe cognitive impairment of bipolar disorder patients comorbid with BPD is more severe than that of patients without comorbid with BPD. ［Funded by Medical Science Research Project of Hebei Province in 2022 （number， 20221407）］

ObjectiveTo observe the early and mid-term clinical effect of occupational therapy on patients after total knee arthroplasty (TKA) during perioperative period. MethodsFrom July to August, 2018, 100 patients who underwent the first TKA in the First Affiliated Hospital of USTC were divided into control group (n = 50) and observation group (n = 50) according to the treatment plan. Both groups received routine preoperative rehabilitation education, surgical treatment and postoperative physical therapy, in addition, the observation group received perioperative occupational therapy. They were assessed with modified Barthel Index (MBI) and Instrumental Activities of Daily Living (IADL) before operation; one, two and three days after operation; on the day of discharge; one month, three months and six months after operation. ResultsOne day, two days, one month, three months and six months after operation, the scores of MBI were higher in the observation group than in the control group (t > 2.113, P < 0.05). One month, three months after operation, the scores of IADL were significantly higher in the observation group than in the control group (t > 5.125, P < 0.001). The postoperative hospitalization time was significantly shorter (t = -5.356, P < 0.001), and the total treatment cost was lower (t = -2.455, P < 0.05) in the observation group than in the control group. ConclusionOccupational therapy could effectively improve the early and mid-term activities of daily living of TKA patients and help them return to normal life earlier.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Objective: To investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability. Methods: Data of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10%-15% from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed. There were 20 males and 7 females with an average age of 30.8 years old (range, 19-50). The bone loss of the glenoid was 10%-15%. The time between the first dislocation and the surgery was 24.1±15.8 months. The patients were treated with arthroscopic autologous scapular spine bone graft transplant. Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks, after that the passive motion was applied. Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months. Constant-Murley score and the Disabilities of Arm, Shoulder and Hand (DASH) score were used to evaluate the shoulder function, and visual analogue score (VAS) score was used to evaluate the degree of pain. Computed tomography scans were obtained one week post-operation and at the latest follow-up, from which the length, width, height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated. The subjective satisfaction degree of patients at the latest follow-up was also recorded. Results: All 27 patients were followed up for 19.8 months (range, 13-39 months). No infection or neurovascular injury was identified. At the latest follow-up, the Constant-Murley score was 85.15±5.62 (range, 76-94), the DASH score 13.39±5.51 (range, 3.19-21.95) and the VAS score 1.29±0.45 (range, 1-2), thus all of those were improved significantly compared to those of pre-operation. At the latest follow-up, the anterior flexion was 153°±24°, lateral rotation by side 38°±21°, internal rotation 70°±21°, and abduction was 139°±18°. At the latest follow-up, the absorption rate of the bone graft was 46.1%±20.6% (range, 24.0%-71.7%). Among all the 27 patients, 19 patients considered the outcome as very good, and 6 patients considered as good, 2 patients fair. Conclusion Arthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10%-15%. This technique could achieve satisfactory clinical results, improve glenohumeral stability, decrease the re-dislocation rate.

To explore diagnostic value of platelet count (PLT) ,plasma D– dimer (D‐D) , antithrombin Ⅲ(AT‐III) levels and UACR for microvascular disease (MVD) in type 2 diabetes mellitus (T2DM).Methods : A total of 284 T2DM patients treated in our hospital were divided into no MVD group (n＝144) and MVD group (n＝140) according to MVD condition .Another 120 healthy people were enrolled as healthy contrrol group .Levels of PLT ,plasma D‐D and AT‐Ⅲ,unine microalbuminuria (UMA) and creatinine (UCr) and UMA／UCr ratio (UACR) were measured and compared a‐mong all groups .The diagnostic value of combined detection of PLT ,plasma D‐D and AT‐Ⅲ levels and above triple detec‐tion combined UACR for MVD in T2DM were analyzed.Results : Compared with healthy control group ,there were signif‐icant reductions in levels of PLT [ (212.34 ± 51.23)×109／L vs.(116.46 ± 46.43)×109／L vs.(98.48 ± 35.66)× 109／L] and plasma AT‐III [(103.54 ± 7.23)% vs.(99.52 ± 4.24)% vs.(75.34 ± 5.31)%] ,and significant rise in levels of plasma D‐D [ (0.31 ± 0.16) mg／L FEU vs.(0.85 ± 0.33) mg／L FEU vs.(1.08 ± 0.52) mg／L FEU] and UCr [ (3.36 ± 1.56) mmol／L vs.(4.51 ± 1.79) mmol／L vs.(12.31 ± 5.12) mmol／L] in no MVD group and MVD group . And levels of PLT and plasma AT‐III of MVD group were significantly lower than those of no MVD group ,plasma D‐D and UCr levels of MVD group were significantly higher than those of no MVD group ( P＜ 0.01 all).Compared with healthy control group ,no MVD group ,there were significant rise in levels of UACR [ (11.25 ± 5.02) mg／mmol vs. (10.01 ± 4.39) mg／mmol vs.(59.89 ± 16.32) mg／mmol] , UMA [ (38.25 ± 17.22) mg／mmol vs.(41.11 ± 18.53) mg／L vs.(722.32 ± 101.54) mg／L] in MVD group ,and UACR of no MVD group was significantly lower than that of health control group (P＜0.05 or 0.01).Compared with single UACR detection and triple combined detection of PLT ,plasma D‐D and AT‐Ⅲ levels ,there were significant rise in sensitivity (85.51% vs.87.82% vs.90.33%) ,specificity (90.54%vs.85.32% vs.94.32%) and accuracy (82.33% vs.84.56% vs.90.21%) in triple detection combined UACR ( P＝0.001 all).Conclusion :Combined detection of PLT ,plasma D‐D and AT‐Ⅲ levels with UACR are significanly superior to combined detection for screening MVD in T2DM.

Objective: To explore the predictive value of the timed "up and go" test on falling of inpatients with stroke, providing objective reference for clinical fall risk evaluation. Methods: A total of 62 stroke in patients who were treated in the department of Neurology of the Second Affiliated Hospital of Shantou University Medical College from January 2018 to June 2018 were selected by the convenience sampling method. The timed "up and go" test was used to record the walking function of stroke inpatients. An ROC curve was used to analyze the efficacy in predicting falls of stroke inpatients. Results: The TUGT has demonstrated intraclass correlation coefficient (ICC) value of 0.963 (95%CI 0.938-0.978), and Cronbach alpha coefficient value of 0.983.The difference of the TUGT time between recurrent-fall stroke inpatients [15.69 (13.30, 19.87) seconds] and the patients without a history of falling [12.45 (10.08, 16.26) seconds] was statistically significant (Z=-2.585, P<0.05). Meanwhile, the difference of the TUGT time between male stroke inpatients [13.12 (10.23, 15.35) seconds] and female stroke inpatients [17.09 (12.98, 19.87) seconds] was also statistically significant (Z=-2.297, P<0.05). The TUGT time was significantly (P<0.05) positively correlated both with the fall history (rs=0.331) and gender (rs=0.294) in stroke inpatients. The result of ROC curve showed that the optimal TUGT cut-off point for predicting the fall of male stroke patients was 13.12 seconds with 0.696 for AUC, 78.6% for sensitivity and 68.2% for specificity (P<0.05).While the optimal TUGT cut-off point for predicting the fall of female stroke inpatients was 13.68 seconds with 0.691 for AUC, 73.3% for sensitivity and 65.6% for specificity (P<0.05). Conclusions Although TUGT has good feasibility in stroke inpatients, its predictive value for future falls of stroke inpatients is medium. The assessment and prediction of fall risk should be considered carefully by medical workers so as to reduce the occurrence of falls in stroke inpatients.

Objective To observe any effect of pulmonary rehabilitation in preventing ventilator-associated pneumonia (VAP) among patients receiving invasive mechanical ventilation (MV). Methods A total of 117 a-dults who had be receiving mechanical ventilation for at least 48 hours were randomly divided into an observation group and a control group. Both groups were given routine drug treatment and nursing, but the observation group al-so received comprehensive and individualized pulmonary rehabilitation interventions including airway clearance, respiration training, electrical stimulation of the sacral nerve, lung expansion and early mobilization. The main indi-cators were the incidence of VAP, mortality, MV duration, ICU stay time, and total hospital stay. Results At the end of the treatment the average clinical pulmonary infection score, the acute physiology and chronic health e-valuation Ⅱ score, SpO2 level and oxygenation index of the observation group were all significantly better than those of the control group. The incidence of VAP within one month after leaving the ICU was 47. 5％ in the observation group and the mortality rate was 44.1％, both significantly lower than in the control group. The average MV dura-tion, total hospitalization time and the ICU stay of the observation group were also significantly shorter than those of the control group. Conclusion Early and comprehensive pulmonary rehabilitation can prevent VAP and shorten the length of hospital stays, ICU stays and time on a mechanical ventilator, improving patients' survival chances and prognoses.

OBJECTIVETo study and design a maternal and fetal monitoring system based on the cloud computing and internet of things, which can monitor and take smart care of the mother and fetus in 24 h.

METHODSUsing a new kind of wireless fetal monitoring detector and a mobile phone, thus the doctor can keep touch with hospital through internet. The mobile terminal was developed on the Android system, which accepted the data of fetal heart rate and uterine contraction transmitted from the wireless detector, exchange information with the server and display the monitoring data and the doctor's advice in real-time.

RESULTSThe mobile phone displayed the fetal heart rate line and uterine contraction line in real-time, recorded the fetus' grow process. It implemented the real-time communication between the doctor and the user, through wireless communication technology.

CONCLUSIONSThe system removes the constraint of traditional telephone cable for users, while the users can get remote monitoring from the medical institutions at home or in the nearest community at any time, providing health and safety guarantee for mother and fetus.

Objective To study and design a maternal and fetal monitoring system based on the cloud computing and internet of things, which can monitor and take smart care of the mother and fetus in 24 h. Methods Using a new kind of wireless fetal monitoring detector and a mobile phone, thus the doctor can keep touch with hospital through internet. The mobile terminal was developed on the Android system, which accepted the data of fetal heart rate and uterine contraction transmitted from the wireless detector, exchange information with the server and display the monitoring data and the doctor’s advice in real-time. Results The mobile phone displayed the fetal heart rate line and uterine contraction line in real-time, recorded the fetus’ grow process. It implemented the real-time communication between the doctor and the user, through wireless communication technology. Conclusions The system removes the constraint of traditional telephone cable for users, while the users can get remote monitoring from the medical institutions at home or in the nearest community at any time, providing health and safety guarantee for mother and fetus.